As a lawyer who regularly assists regulated health professionals (RHPs) in matters before their respective Discipline Committees, I wanted to alert RHPs about an increasing trend on the part of a number of extended health insurance companies.
Namely, in my experience, certain insurers are now actively reviewing the Discipline Committee decisions of various health professions colleges (which are posted online) and are proceeding to "de-list" RHPs who have been suspended in respect of "billing-related" conduct.
In such cases, the RHP will typically receive a short letter from the insurer advising that they have been de-listed as an approved provider due to administrative and/or billing practices, with no further information provided.
Speaking from experience, I know that it is extremely difficult to convince an insurer to set aside a de-listing decision - even after the passage of several years and the completion of restitution and/or remediation.
Needless to say, being de-listed by one or more insurance companies can have a crippling economic effect on an RHP, and in numerous instances, it has resulted in the RHP voluntary ceasing to practice their profession.
It is imperative that RHPs (and their counsel) are aware of this new reality and keep it in mind when responding to complaints and in considering resolutions before their respective Discipline Committees. It should also re-enforce the importance of ensuring that accounts are being submitted in accordance with all applicable college/insurer rules. A PDF version is available to download here.
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