VGM Thwarts Narrowing of Provider Networks

WATERLOO, Iowa (March 28, 2018)—VGM recently helped solidify an important win for providers of sleep-related equipment in Maryland, D.C. and Virginia.

VGM took action after members raised concerns over a letter received from CareFirst BlueCross BlueShield. In the letter, CareFirst notified providers of its intentions to reduce the number of durable medical equipment providers participating in the network authorized to dispense CPAP equipment.

CareFirst’s notification stated that beginning February 15, participating providers would no longer provide sleep related equipment setups for CareFirst members. After February 15, 2019, all replacement supplies and CareFirst members would be transitioned to a select few providers. 

Upon hearing of CareFirst’s decision, VGM conducted research and reached out to several channels and ended up filing a complaint with the Maryland Insurance Administration (MIA). Following some correspondence with MIA, which was in contact with CareFirst, a resolution was reached.

“We’re proud that our due diligence and persistence helped to protect providers in this respective area,” stated Craig Douglas, VGM’s vice president of payer and member relations. “I was pleased with the timely response and results from the Maryland Insurance Association’s investigation into this case.”

In a letter sent to Douglas, MIA stated, “CareFirst initially decided to reduce the number of DME providers who would provide CPAP supplies to its members. While they have not rescinded their decision, CareFirst has since amended it.” 

According to a letter sent to MIA’s senior complaint investigator, CareFirst noted they would now allow any contracted provider to continue to provide sleep-related equipment at the contracted reimbursement rate as long as providers meet a set of requirements. 

“This is a prime example of how VGM continues to support the DME industry and precisely why we put Craig into the payer and member relations role,” stated Clint Geffert, president of VGM & Associates. “We want to make sure our membership community has access to as many payers as possible to provide better access for patients and their families. Craig’s efforts helped protect those opportunities and bring this portion of business back to these providers.” 

Douglas’ efforts helped win this round, but he is quick to note that these victories can only happen if DME providers remain attentive and persistent if something seems questionable with a payer source. 

“It’s important for providers to know that they do not have to take things at face value from payers,” mentioned Douglas. “If something seems questionable, reach out to your resources to help do some investigating on your behalf.”

Visit vgmgroup.com for more information.