If a health plan rates you for one of its physician ranking or tiering programs based on cost or quality of care, you don't have to take the results lying down. But you do need to act within 30 days of receiving your preliminary ranking results from the health plan.
In the 2009 Texas Legislature, TMA won physicians the right to dispute their ranking or classification before the insurance company publishes it. Now, TMA has a tool to help you exercise your rights under the law. "Basic Steps for Reviewing and Disputing Physician Rankings and Tierings" walks you through the procedure to appeal your ranking under such programs as Aetna Aexcel, Blue Cross and Blue Shield of Texas Blue Compare, CIGNA Care, and UnitedHealth Premium.
TMA remains opposed to any institution or company publicly profiling and penalizing individual physicians based on faulty methodology. That's why TMA made sure the 2009 law requires health plans to base individual physician rankings only on bona fide, nationally recognized guidelines.
In addition, the law says physicians currently in clinical practice must be actively involved in developing standards used in the health benefit plan's comparison program, whose measures and methodology must be transparent and valid.
You'll find more information and resources on the Physician Ranking page of the TMA website.
If you have questions or need help, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email.
Action, May 15, 2012