Dermatology                                                                                                                                             Allergy

Effective January first 2000 this office will no longer accept the "State Employees
Insurance".

The reason for this is that the new insurance carrier has refused to offer a contract that
meets industry standards in this area. The following items represent a small portion of the
"problems"

    No list of what is covered and not covered

    No fee schedule. That is to say they will not disclose what they will pay for office visits, surgeries , etc.

    Furthermore, as I read the contract, they can change the amount that they pay at their discretion.

    There is no requirement for them to pay on any timetable. Industry standards is to
    pay "clean claims" in 30-45 days (this includes Medicare, Medicaid, Blue Cross,
    Baptist, etc.) The only guarantee of payment is "eventually". I would like to point
    out that the payments for office visits for the State Employees has remained the
    same for the last 4-5 Years; my overhead has not.

    There is no provision for dealing with disputes. In fact according to the contract:
    If I have to sue them to get my money, and I am right and they are dead wrong, I
    still have to pay my own attorneys fees.

To make a long story short there are over 20 objectionable commissions or omissions in
the contract I was sent. At least 9 of these are independently fatal and would preclude
my signing a contract with this company. There is even an implication that the contract is
contingent on "attached documents"... There are none now but might they be added later?

I will continue to try and work with insurance carriers, for the benefit of my patients,
whenever possible. Approximately 10% of our gross office collections are spent dealing
with insurance and billing. This is to your benefit and I don't mind as long, as it is done
in, what I consider to be a responsible manner.

A copy of the proposed contract is immediately available to any patient who requests it.

                    Philip Loria MD