Envision CEO Chris Holden said during a first-quarter earnings call May 8, “We strongly believe payers, regulators and providers must work collaboratively. We object to many of the current payer tactics that fuel conflict and adversely impact the unique relationship between patient and physician.”
Mr. Holden said challenging the prudent layperson standard is one tactic insurers are using to fuel conflict. The prudent layperson standard refers to a person who has an average understanding of healthcare presenting to the ED with symptoms he or she would deem emergent. Mr. Holden said insurers are changing their policies to base coverage on the final diagnosis in the ED and not presenting symptoms.
Other insurer strategies include payment denials and shifting cost burden to employers and patients, Mr. Holden said, according to the Nashville Business Journal.
Envision has been making headlines during a public fight with UnitedHealthcare over their contract. In April, a district court tossed Envision’s lawsuit against UnitedHealthcare, effectively compelling the parties to resolve a lengthy legal dispute through arbitration.
Mr. Holden said Envision is aiming to lobby for more transparent billing and payment systems under its “Patients First Initiative.” Envision is also working to move most of its payer contracts to in-network status, an effort the provider announced at the beginning of 2017.
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