11/25/2025
Dear WPPC Peeps,
We are for sure in trying times. Insurance changes has us all going bonkers for sure. There has been a few questions so I will answer globally.
As a provider, I am credentialed with each and every insurance. There are many BC/BS, Tricare, UHC plans and the like. For many years I have been credentialed with UHC and in that umbrella is several UHC type plans. When there was a data breach many and I mean many of us that have been around and grandfathered in got dropped off. I did not even know this until patients with some of those plans either showed up for visits or my biller told me. I have tried again to be placed back into those plans but they shut the panel for all of us affected. This is why medicare attached type plans are also having to find plans because insurances have gone bat crap crazy. Now, do I still have UHC plans?????? YEP. It is a question that gets answered when we run eligibility. It is a tough time as many are trying to find not only new plans but will the medications that have been on continue within the new plan. I for one am on two injectables that because of a 100% tarriff on one of them is now gone from my formulary and the other is just dropped without a reason.
In the end I wish I had a crystal ball but if is going to be quite the ride come january. Here is what I ask. I am small potatoes compared to the Medstars and Luminus organizations. I really operate on a shoestring literally so be mindful of those pesky deductibles, copays and co insurances. If of course there are questions my biller will talk to you about it. I think about money when the SMECO bill is due but she operates the day to day and knows the skinny about insurances. I would rather my time be with you all, my patients. Mistakes are made and as soon as I know the issue I bring billing in to sort it out.
It is difficult to predict what will happen but fingers crossed for all of us.
For now let us think turkey and enjoy the day with our own peeps.
Dr. M