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HealthAmerica
Termination and Appeal Hearing
HealthAmerica violated crucial protocol, professional courtesy and common sense when they interrupted Dr. Berwick's service by prematurely notifying hundreds of loyal patients that her contract was terminated. Additionally, her patients were instructed in the same letter to select a new Primary Care Doctor within 30 days. HealthAmerica did not notify Dr. Berwick first, and allow for her entitled appeal process to settle the issue. Her HealthAmerica patients called Dr. Berwick's office with concerns before she read the termination notification herself. First Patient Letter Dr. Berwick received a Termination of Contract Letter from HealthAmerica HealthAssurance Pennsylvania, Inc. dated February 15, 2006. An appeal was immediately filed by Dr. Berwick and a hearing was scheduled for March 7, 2006. HealthAmerica's decision to terminate Dr. Berwick and their irrational protocol violation is additional evidence of the devastating consequences resulting from the UPMC Attending Physician erroneous P.H.P. referral made over three and a half years ago.Dr. Berwick's Termination Letter HealthAmerica's Appeal Notification Dr. Berwick's General Business Manager/Husband Robert P. Hussey sent a CD copy of "The Medigate Case" to the appropriate HealthAmerica representative so that the extenuating circumstances involved in her termination could be reviewed. Dr. Berwick and Mr. Hussey participated in the hearing by teleconference. Also participating was Charles O. Stuart documentation specialist. Health America's attorney stated that the termination of contract was due to a violation of a policy requirement for General Practitioners to have admission privileges at an area hospital. The attorney followed by asking Dr. Berwick, "Do you have admission privileges at any area hospital?" A "no" response was offered. Mr. Hussey attempted to ask for additional consideration due the highly irregular circumstances involved in her hospital terminations. However, the HealthAmerica attorney cut short any attempt to stray from the direct procedural violation issue and continuously interfered, not permitting Mr. Hussey or Dr. Berwick to effectively speak in defense of the issues related to her termination. The attorney continued to cut short much of their discourse. At the end of the hearing Mr. Stuart interjected and asked to cut through the attorney and direct his discourse to the doctors who were to vote on the termination of Dr. Berwick's contract. He recommended that prior to voting they take time to review a Highmark Second Level Hearing Transcript located on "The Medigate Case" CD submitted prior to the hearing. Mr. Stuart explained that the purpose was to understand the progression of reasoning that resulted in the Medical Review Committee's ruling to overturn the First Level Hearing decision to terminate Dr. Berwick as a provider. The voting members agreed to do so. Note: The Highmark Second Level Hearing was a monumental milestone in the case for Evelyn S. Berwick M.D. because the Medical Review Committee, which consisted of 15 members (13 of which were Medical Doctors) voted in support of Dr. Berwick and ruled that the decision to terminate her as a network provider should be overturned. We are pleased to report the second milestone in The Medigate Case. HealthAmerica's Medical Review Committee ruled to overturn the decision to terminate Dr. Berwick. Once again a panel of doctors saw the facts in this case and voted their conscience. Just as in the previous Highmark vote, the wall of injustice continues to crack. In the letter of ruling HealthAmerica claimed that she shall be reinstated without interruption. However, her services were already greatly interrupted and many faithful patients obtained other doctor's services as directed by the first HealthAmerica letter. Appeal Hearing Ruling - Termination Overturned Health America informed Dr. Berwick's patients in a follow-up letter that she was still participating in their provider program. However Mr. Hussey was told by the top HealthAmerica official that they could not assure that all patients originally notified had received the follow-up letter. Mr. Hussey attempted to obtain an accurate list of patients who received the premature termination letter. However, the HealthAmerica official could not assure that the data would be accurate. Patient Notification Follow-Up Letter Recently, Dr. Berwick received a list of her HealthAmerica insured patients. Tragically, the new list contains only 17 of the estimated 700 HealthAmerica patients who were on the list prior to the premature termination notification. |