Insurance anti-assignment clauses
By Franklin J. Rooks Jr, PT, MBA, Esq
Many physicians have come to the conclusion that some insurance contracts are not worth having. More and more physician specialties have opted out of participating provider contracts or have chosen not to participate in the first place. Reimbursement amount is the primary reason for not participating. The amount allowed for various CPT codes simply is not enough. On top of that, there is Multiple Procedure Payment Reduction (MPPR). This ominous concept was crafted by the Centers for Medicare & Medicaid Services (CMS). The MPPR functions to reduce the allowable amount of multiple medical procedures performed during the same session by the same provider.1 Insurance carriers, such as United Healthcare, have modeled their reimbursement on this CMS policy and implemented their own versions of the MPPR.2 Often, in-network reimbursement is not commensurate with the education, skill, and value that the physician delivers.