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History of Project FAIR
Project FAIR (Focused Advocacy for Insurance Reform) was created by the OPA, and initially funded in large part by the APA to address the mounting concerns psychologists had with managed care and insurance company problems. Glenn Karr, an attorney who had been volunteering with the OPA, was instrumental in putting the Project FAIR proposal together. He stayed in that role until 2003.
One of the first problems FAIR tackled was Anthem Insurance’s failure to provide proper notification of the psychologists’ rate change. Anthem denied any liability, but agreed to pay to psychologists and other mental health care workers over $400,000 to settle the dispute.
Another major problem FAIR addressed was with QualChoice, an HMO operating in the Cleveland area. Their payments to psychologists were lagging months behind. Through extremely tough negotiations, and using the Prompt Pay Law, which requires payment within 24 days after receipt of a completed claim as a threat, OPA negotiated a six-month extension of existing rates to be paid to psychologists, which had been cut by every other carrier in the Cleveland area. QualChoice also agreed to add an OPA recommended psychologist to their Provider Relations Committee, and as a result the OPA at least has some input to decisions when they are being formulated.
FAIR, with funding from APA, also conducted an analysis of OPA member claims. The data was instrumental in the passage of SB4 in the 124th General Assembly. This law establishes effective claim processing systems and requires payment of clean claims in 30 days.It has proven to be a major improvement over the previous legislation governing payment to health care providers.
The Mission of Project FAIR
- Analyze the practices of insurance companies and MCOs in Ohio
- Identify patterns of abuse
- Address the problems and abuses directly with the insurance companies and MCOs
- Refer insurance practices violations to appropriate regulatory agencies if necessary
Insurance Troubles? Here’s What You Can Do
The Department of Insurance wants to hear from psychologists about problems with insurers. They report receiving few formal complaints from psychologists. The Department has jurisdiction over companies that are regulated by the state of Ohio.
Some self-insured companies do not have to follow Ohio law because of the ERISA exemption. (After the federal parity law went into effect on Jan. 10, 2010, there were fewer exemptions for self-insured companies regarding mental health coverage.)
The Ohio legislature, with help from OPA’s advocacy efforts, gave the Department of Insurance the right to enforce complaints against insurers in two areas:
- Prompt Pay Complaints (requires insurers to pay clean claims in 30 days or pay interest). Read the FAQs on the Prompt Pay Law for more information.
- Credentialing and Contract Complaints (House Bill 125) requires quick credentialing, transparent contracts, no-changes in mid-term of contract without agreement by psychologist and more. The Mental Health Toolkit from the department contains more information.
Please complete the Project F.A.I.R, Issue Report Form, so that we can document the problems.
If you have any problems with insurers and need assistance contact OPA at 614.224.0034. Members can join the OPA Insurance Committee to help fight insurance problems faced by our colleagues and our patients.
The Goals of Project FAIR
- Influence policy
- Advocate for the highest possible reimbursement rates for psychologists
- Advocate for less paper work
- Advocate for less utilization review
- Improve protections of patient confidentiality
- Serve as a buffer between psychologists and MCOs, advocating changes without putting individual psychologists at risk
- Increase the percentage of health care dollars spent on psychological care
- Identify patterns and practices which may represent legal or regulatory abuse by individual insurance companies or MCO’s
- Advocate on behalf of members to resolve problems with insurers
- Keep members informed about insurers in Ohio
- Access to treatment is limited
- Patients have little choice of which provider they may see
- Access to membership on panels is limited
- Ethical dilemmas about quality care confront psychologists daily
- Reimbursement rates are falling
- Patient confidentiality is frequently compromised
- Paperwork is growing