11/08/2016

Fidelis Repayment Requests

Members have contacted NYSPMA regarding Fidelis correspondence about overpayment on secondary surgical codes.
Specifically, Fidelis states they should  have reduced secondary surgical procedure codes by 50%, but failed to do so. Fidelis is seeking repayment for all procedures they state were inappropriately reimbursed over the last 24 months.

NYSPMA is well aware of the situation and aggressively using our legal, billing and insurance consultants to better understand the legality and rationale for the requests. In the meantime, we do recommend the following course of action:

1. Go through the appeal process. It is important to preserve your rights by appealing the repayment request by going on record ASAP – asking specifically for the contractual language or state policy which provides for this recoupment. Be sure to appeal in a traceable form (written, email, or fax) and get your response in writing.
   If you are not comfortable doing this on your own or have concerns about the process, please consider legal assistance and the two options below.
2. Get your liability/malpractice insurance provider involved. Your insurance provider MAY have legal representation built into your policy so check with your insurance plan. We have contacted PICA and have been informed they will provide legal representation to their policyholders on this matter. Call them at 615-371-8776 and ask for Karen Kessler.
3. Podiatry Protection Program. If you do not have coverage through your insurance provider, but you have invested in the NYSPMA PPP, you also may qualify for legal protection. Call Feldman Kieffer at 716-852-5875.