The ongoing dispute between CCS Oncology and Independent Health over insurance coverage has now made its way to court.
Dr. W. Sam Yi, CEO of CCS, tells 7 Eyewitness News that his medical group has filed a lawsuit in NYS Supreme Court against Independent Health for planning to drop CCS Oncologists from the IHA network starting in January 2017.
As part of the legal action, Dr. Yi said CCS is also seeking an injunction to allow IHA covered cancer patients to continue seeing CCS oncologists while the lawsuit proceeds. Dr. Yi is hoping the court will act on the injunction request before the end of the year.
Dr. Yi spoke with 7 Eyewitness News Reporter Ed Reilly by phone and you can hear a portion of that conversation in the attached video clip.
"To me, that is putting money over cancer patients. To me, that is absolutely unacceptable," said Dr. W. Sam Yi.
Dr. Yi said the decision has impacted over 500 active cancer treatment patients and threatens to reduce choices for those who are diagnosed with the disease in the future.
"These patients are fighting for their lives and now they have to fight the insurance company," said a CCS staff employee who added that she is fielding calls from tearful patients.
Independent Health said the decision was necessary to control rising cancer treatment cost. The health insurance company said it was helping patients find new oncologists and took steps to provide longer-than-required notice.
CCS Oncololgy has also created a hotline to answer patient questions at (716) 932-7779.
The following is a statement released by Independent Health on the dispute:
“We first reached out to CCS to begin discussing an alternative reimbursement model in March 2015. Throughout a 16-month period we met with CCS officials approximately a dozen times to review and share data and other pertinent information. We even updated and revised data reports based on CCS’s feedback. The information provided to CCS was consistent with data analysis methodology used with our other provider partners.
“As of June 2016 we were unable to agree on a value-based reimbursement model. This was significant because we are required to file most of our 2017 products to the state or federal governments by mid-year, including networks and benefits, in order to ensure our products are actuarially sound and priced appropriately.
“While we are aware CCS has filed a complaint in state court, it is important to clarify that we have not been served with that complaint; therefore no lawsuit has yet commenced. Nevertheless, it is our firm contention that Independent Health followed all regulatory and contractual requirements for the non-renewal of the physician contracts. In fact, we provided the physicians and the most affected members with substantially more advance notice than was required by both statute and contract.
“Also, in conformance with federal regulations for Medicare, an appeal of the non-renewal was provided and was heard in August before a panel of five community physicians (not employed by Independent Health), several of whom were oncologists. After a thorough presentation of documentary evidence and testimony, including argument and testimony relating to the data that was provided to CCS during the negotiation process, the appeal panel ruled in Independent Health’s favor. We do not believe that there are any new issues that could be subject in this potential lawsuit that have not already been decided in favor of Independent Health. As such, we firmly believe that there is neither legal nor factual support in the complaint that has been filed. ”
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