I am finally getting more grounded in the Act 129 meeting process. Briefly, this is where Vt. Dept. of Banking, Insurance, Securities, and Healthcare Administration (BISHCA) puts in to legislative processes the rules governing managed care, healthcare, and oversight. The most relevant topics center around consumer protections regarding access to care, coverage for emergency services, and protection and appeals processes for denial of care issues.
As far as I can determine, however, protection for providers (you and me, for example) has a very limited invitation to be heard. Reimbursement rates are clearly “off the table,” and the insurance company representatives react angrily when we try to discuss opening up billing code option so that quality care can be fully reimbursed. Examples would include reimbursement for crisis contact by telephone, extended family and group sessions, and case management services for complex cases. To be fair, some companies are better than others in covering some of this. The point is that there is resistance to discussing how to remove these barriers to treatment in this meeting. Continue reading