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Surprise Insurance Coverage Gaps


Dr. Matt Keady and Dr. Mark Bernardy

Surprise Insurance Coverage Gaps

After receiving emergency care at an “in-network” hospital, patients often discover that they
received care from an “out-of- network” physician and owe a lot of money. This is the “surprise
insurance coverage gap.” The patient pays their monthly premium, yet they receive unexpected
“balance bills” for amounts their insurance company refuses to cover – keeping in mind the
insurers are narrowing their networks to reduce costs and maximize profits by subjecting
physicians to inadequate, take-it- or-leave- it contracts.

Physicians in Georgia believe that it is critical to end the surprise insurance gap in emergency
medicine care settings. Physicians have seen their patients’ financial burden increase in dramatic
ways as health insurance companies have narrowed their networks. Health insurance is so
ambiguous that the most sophisticated patients have trouble understanding the rules.

Many patients try to do the right thing and go to a hospital that is in their insurance network during an
emergency – but they often don’t have any way of knowing when a doctor they need to see is in or
out of their network.  The Medical Association Georgia and other physician and patient advocacy organizations are calling for state lawmakers to put an end to balance billing in emergency care settings by passing legislation that will close the surprise coverage gap. MAG is also supporting the ‘End the Surprise Insurance Gap’ campaign.

Dr. Matthew Keadey has been an emergency physician in the Atlanta area for nearly 20 years. He
began his career at Emory Healthcare. He now works in the Emory and Grady Health systems. He
is the president-elect of the Georgia College of Emergency Physicians, and he is a member of the
Medical Association of Georgia. Dr. Keadey is an expert in emergency department billing, coding
and reimbursement.

Dr. Mark Bernardy has been a private practice general/interventional radiologist in Georgia for 30
years. He is a member of the Georgia Radiological Society’s Board of Directors. Dr. Bernardy is
the vice chair of the American College of Radiology’s Economics Commission and a board
member of the Radiology Business Management Association. He is active in Georgia politics,
advocating for radiologists, physicians, and patients. His advocacy efforts started with colon
cancer screening.

Drs. Keadey and Bernardy are leading advocates for ensuring that patients have access to fair
insurance coverage in emergency care settings in Georgia.

Blue Cross Blue Shield of Georgia

Blue Cross Blue Shield of Georgia

Blue Cross Blue Shield of GA CEO, Jeff Fusile

Blue Cross Blue Shield of Georgia

On this week’s episode with our partner, Medical Association of Georgia, MAG CEO, Donald Palmisano, Jr., joined me in studio.  We hosted Jeff Fusile, the recently-appointed President for Blue Cross Blue Shield of Georgia.  Jeff joined the company in the lead role, coming over from Anthem in November of 2015.

Jeff Fusile is president of Blue Cross and Blue Shield of Georgia (BCBSGa), the state’s oldest and largest health insurance company. He oversees sales, account service, marketing, underwriting, and customer relationships. Jeff is involved in corporate strategy planning and execution, and he serves as the primary contact for state regulators to ensure compliance and manage any state-related matters.

Jeff previously served as Senior Vice President and Chief Financial Officer for the Commercial & Specialty Business Division of Anthem, Inc., which is Blue Cross and Blue Shield’s parent company. He joined Anthem in 2011 after spending 22 years as a strategic management consultant with PricewaterhouseCoopers. Jeff is a licensed CPA. He has qualified as an expert witness in insurance and the broader health care industry. He is widely recognized as an industry leader in health care strategy, corporate governance, compliance, enterprise risk management, HIPAA, and ICD-10.

As the health care landscape undergoes an unprecedented transformation, the traditional relationships between providers and payers are also evolving. With the largest network of providers in the state, Blue Cross and Blue Shield of Georgia (BCBSGa) serves more than 3 million Georgians and is the only plan offered in all 159 counties.  BCBSGa President Jeff Fusile will discuss how BCBSGa is developing programs to facilitate better collaboration with providers, make health care more affordable for consumers and simplify the access to care. Reaching out to rural communities and the impact of technology on delivering innovative solutions was also discussed.

Special Guest:

Jeff Fusile, CEO, Blue Cross Blue Shield of Georgia  linkedin_small1  twitter_logo_small-e1403698475314  facebook_logo_small3  youtube logo


  • BS, Accounting & Finance, Florida State University College of Business
  • Certified Public Accountant
  • Previous Managing Partner, PriceWaterhouseCoopers
  • Former Senior VP/CFO, Commercial & Specialty Business, Anthem

Health Insurance Mergers

Medical Association of Georgia

Donald Palmisano Jr.

Medical Association of Georgia

Dr. John Rogers of Coliseum Northside Hospital

Health Insurance Mergers

On this week’s episode I continued my monthly series with Medical Association of Georgia. MAG CEO, Donald Palmisano, Jr., and MAG delegate from Bibb County, Dr. John Rogers joined me in studio to talk about the challenges and concerns arising from recently-proposed mergers between large health insurance companies that will significantly reduce amount of competition in the space for Georgians to choose from.

Aetna/Humana and Anthem/Cigna are in the process of merging. At the same time, health insurers are offering insurance policies to the public that do not have adequate coverage resulting in more out of network charges by physicians.

Aetna/Humana and Wellpoint/Cigna have proposed mergers in the health insurance market. If these inadequate policies are being offered in the current environment, MAG is concerned about how patients will be negatively impacted with a further narrowing of the networks and increased physician reliance on out of network charges.

MAG recently sent a letter to the U.S. Department of Justice to call for it to scrutinize the mergers for antitrust violations.

MAG believes the mergers would reduce competition and place physicians and their patients at an even greater disadvantage as a shrinking number of health insurance companies gain increasingly-dominant positions in the marketplace.

The new Aetna (58 percent) and Anthem (30 percent) entities would control nearly 90 percent of the individual market in Georgia. In the small group market, Aetna would control more than 49 percent, while Anthem would control more than 33 percent. Each new company would control about 26 percent of the Medicare Title XVIII marketplace. And for large group market, Aetna would control more than 12 percent while Anthem would control nearly 55 percent.

Physicians have little-to-no leverage to negotiate contract terms with these multi-billion dollar conglomerates – which are imposing take-it-or-leave it agreements and unilateral, mid-term amendments with growing impunity.

Gone unchecked, a few insurers will be in a position to manipulate the marketplace to institute policies that will exacerbate the physician shortage and undermine the economic viability of the practice environment in the state and limit the accessibility of care and individual patient choice.

Georgia Department of Insurance has expressed concerns that the Aetna/Humana merger would violate Georgia’s standards for competition. Specifically, DOI has shared that the Aetna/Humana merger may violate Georgia’s competitive standard in the individual, small group, and Medicare Title XVIII markets while raising concerns of substantially reduced competition in the large group market.

More than 30 percent of the physicians in Georgia who participated in a survey that MAG conducted in the last several months said that they believe that the Aetna/Humana merger would threaten the long-term viability of their practice.

Special Guests:

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia  twitter_logo_small  linkedin_small1  facebook_logo_small3

Medical Association of Georgia

  • JD Law, Loyola School of Law
  • Board of Directors, Physician Advocacy Institute
  • Medical Payment Subcommitte Member, State Board of Workers’ Compensation
  • Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
  • Former Director, Government Relations/General Counsel/Director, GAMPAC

Dr. John Rogers, Co-Medical Director, Coliseum Northside Hospital

Coliseum Northside Hospital

  • Member, Board of Directors, Bibb County Medical Society
  • Vice President, American College of Emergency Physicians
  • Doctor of Medicine, University of Iowa Carver College of Medicine
  • Residency, Medical Center of Central Georgia

GA SB 158

GA SB 158

Cindy Zeldin and Donald Palmisano, Jr talk GA SB 158

GA SB 158

This week we continue our monthly series with Medical Association of Georgia.  I hosted MAG CEO/Executive Director, Donald J. Palmisano, Jr., and Cindy Zeldin, Executive Director for Georgians for a Healthy Future.  We talked about the challenges Georgians face regarding the lack of information available to them about how inclusive health plans are regarding what physicians, hospitals, etc., are included in the plans.

Donald talked about how on the healthcare exchanges, patients must review every plan one at a time, checking the physician directories for each one to see if the physician(s) they need are there.  In many cases, this means going through as many as 30-80 unique plans.

This is complicated by the fact that in many cases, the listed physician directories are incorrect, or change frequently, leading patients to make their choices based on outdated/inaccurate information.

In the Georgia legislature, the senate is considering SB 158, aimed at addressing the issue of transparency in the health insurance space so patients and physicians can make sense out of this important part of how we access healthcare today.

Cindy joined Donald to talk about how Georgians for a Healthy Future has been advocating on behalf of the state’s citizens to help them get signed up for the newly-available health plans on the exchange.  She shared how last year, over 500,000 people gained access to new health plans.

We discussed the need for these patients to get educated about how to

Special Guestsplan for the financial obligations they will face regarding co-pays, co-insurance, deductibles, etc.  Folks need to learn what each of these are and have a plan for how to handle them.  One such strategy is having a health savings account, which allows them to pay for their healthcare costs with pre-tax dollars out of an account that will grow over time.

We also talked about how important it is for physicians and citizens to engage with their state legislators to talk about how these issues affect them in their daily lives.  SB 158 is still in the early stages, with decisions being made on it coming next spring.

Special Guests:

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia  twitter_logo_small  linkedin_small1  facebook_logo_small3

Medical Association of Georgia

  • JD Law, Loyola School of Law
  • Board of Directors, Physician Advocacy Institute
  • Medical Payment Subcommitte Member, State Board of Workers’ Compensation
  • Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
  • Former Director, Government Relations/General Counsel/Director, GAMPAC

Cindy Zeldin, Executive Director, Georgians for a Healthy Future  linkedin_small1  twitter_logo_small-e1403698475314

Georgians for a Healthy Future

  • Master of Arts, Public Policy with focus on Women’s Studies, The George Washington University
  • Master of Public Health, Public Policy, Emory University
  • Previous Principal Management Analyst, Healthcare Div., Dept. of Audits, State of Georgia
  • Former Senior Program Associate, Health Policy Program, New America Foundation

Dr. Rolf Meinhold MDVIP



Dr. Rolf Meinhold MDVIP

On this week’s show I was joined in studio by Dr. Rolf Meinhold MDVIP.  We were introduced to him by Justin Knott of Intrepy, LLC, a marketing firm with numerous local physician practices they serve.  He’s a family practice physician who’s been practicing in the Atlanta area for around thirty years.  He recently joined MDVIP to provide primary care services in their personalized healthcare program.  Through their service MDVIP and its doctors are able to include access to the physician 24/7, coupled with online resources that give patients access to their health information.  MDVIP offers a membership-based plan that provides such extended access to one’s physician with same-day or next-day appointments and 30 min appointment slots, Dr. Meinhold’s patients get significant time and access to their doctor.

Meinhold Family Practice is a MDVIP-affiliated practice utilizing the MDVIP Wellness Program to prevent little things from becoming big things…enabling patients to enjoy life and stay healthy. 
Patients that truly value their health will appreciate having an enhanced doctor-patient relationship. Our practice through MDVIP has dramatically decreased our practice size to closely work with you. Within our smaller practice, you will receive the comprehensive care and personalized service you deserve to keep you healthy.

Dr. Meinhold’s Approach to Your Wellness: Improving the quality of people’s lives one patient at a time, speaks to two essential elements: Quality and Personalization. Improving quality is all about wellness. The better someone is and feels the more possibilities of enjoying the richness that life has to offer. Being person-oriented means giving respect and reverence to the unique relationship that exists between a doctor and a patient. Only by optimizing trust and care can wellness be achieved.

Because of Dr. Meinhold’s specialized training, he is able to manage middle to late childhood, adolescent and adult patients. He has an ongoing interest in the primary prevention of diabetes and heart disease through nutrition and weight management. In addition,  he is a strong proponent of exploring the scientific basis for the mind-body connection in medicine.

Special Guest:

Dr. Rolf Meinhold, MD, Meinhold Family Medicine/MDVIP  facebook_logo_small3  twitter_logo_small-e1403698475314


  • Doctorate of Medicine, Vanderbilt University School of Medicine
  • Internship, Riverside Regional Medical Center
  • Board Certified, American Board of Family Medicine
  • Fluent in English and German

Justin Knott, Co-Founder, Intrepy, LLC  twitter_logo_small-e1403698475314  linkedin_small1

Intrepy, LLC

  •  Previous VP Business Development, TAGin
  • Former Director, Investments, I4 Capital Partners
  • Previous Team Leader, B.A.S.E. Camp Children’s Cancer Foundation
  • BS, Finance, Investments, & Securities, University of Central Florida

Mitochondrial Diseases and Hyperbaric Medicine

Mito TDR

Mitochondrial Diseases and Hyperbaric Medicine

This week I sat down with experts in the fields of mitochondrial diseases and hyperbaric medicine.  Each cell in our body has an “engine” where the nutrition we consume through eating is converted to the energy we need to function and survive.  These engines are known as “Mitochondria”.  These cellular components use genetic code to function and on occasion there will be problems with the genetic code or with how it is decoded.  In these cases, a variety of health problems can reveal themselves, depending on what sort of tissue is made up by these cells in question.  These can range from challenges with learning, developmental problems, or disease states such as Alzheimer’s, Parkinson’s, Muscular Dystrophy, and others.  Dr. John Shoffner, neurologist and geneticist of Medical Neurogenetics came by with Laura Stanley of the Foundation for Mitochondrial Medicine.


We talked about the research Dr. Shoffner is doing in an effort to find medical therapies that could help patients who are dealing with the variety of disorders caused by mitochondrial dysfunction.  We talked about how challenging it can be to identify a health problem(s) that are caused by mitochondrial disease unless a patient’s family is fortunate enough to be seen by a physician familiar with the genetic tests that can be utilized to diagnose them.

As described by the Foundation for Mitochondrial Medicine, “Every aspect of our beings – seeing, breathing, thinking, moving – requires energy. Mitochondria, often called the cells’ “powerhouses,” supply that energy by turning raw materials found in the food we eat and in the air we breathe into a substance called ATP (adenosine triphosphate), which our cells can use as fuel. ATP is, quite simply, vital to life.  Without enough ATP, children cannot appropriately develop, grow, learn, move, or even sleep. Adults without enough ATP are unable to sustain brain, muscle, and other vital organ function. A deficit of ATP can also cause invisible damage in some disease states, leading to early failure or dysfunction of organs, or just a chronic state of inefficiency leading to pain, fatigue, changes or limitations in thinking and learning, and increased susceptibility to acquired diseases.

Laura and Dr. Shoffner shared how they are working to improve awareness of mitochondrial diseases and through research, uncover treatments to halt or at  least slow the effects of these diseases.  The ultimate goal is to find a way to prevent or reverse these problems.
Dr. Helen Gelly joined us to talk about a recent article she co-authored with Dr. Caroline Fife in Today’s Wound Clinic, called, “Hyperbaric Oxygen Therapy in Wound Care: A Service Under True Pressure“.  In the article, Dr. Gelly and Dr. Fife talked about how numerous Medicare Administrative Contractors and Commercial insurers are making changes to indications they are willing to reimburse hyperbaric oxygen therapy for.  That means that patients with wounds that place them at risk for amputation or for degraded quality of life due to previous radiation therapy may not be able to receive this evidence-based, effective treatment.  We talked about how in some cases where the providers in a given MAC were asked for clinical documentation of their HBO treatments provided, as many as 30% failed to respond.  Dr. Gelly shared how this lack of response leads to suspicions of fraud.

It was clear from the Today’s Wound Clinic article and from our conversation that hyperbaric medicine specialists must begin to activate and collaborate to protect this evidence-proven treatment modality.  HBO providers need to not only be responsive to requests for data but ACTIVE as it relates to advocating on behalf of educated decisions being made as it relates to the availability of the modality for tomorrow’s patients in need.

Special Guests:

Dr. John Shoffer, MD, CEO of  Medical Neurogenics 


  • Former Associate professor of neurology and molecular medicine at Emory University
  • Former Director of the molecular diagnostics program at Children’s Healthcare of Atlanta
  • Discovered some of the first gene mutations causing mitochondrial diseases and one of the first genes causing epilepsy
  • Finalist, 2012 Atlanta Business Chronicle’s Health-Care Heroes Awards

Laura Stanley, of Foundation for Mitochondrial Medicine  feed logo  facebook_logo_small3  twitter_logo_small  youtube logo


  • IMBA, University of South Carolina Darla Moore School of Business
  • Former Senior Associate, Korn Ferry
  • Former Vice President, EzGov
  • Parent of a child with mitochondrial disease

Dr. Helen Gelly, MD of HyperbaRXs  twitter_logo_small  google-plus-logo-red-265px  facebook_logo_small3  linkedin_small1


  • Doctor of Medicine, Emory University School of Medicine
  • Internship/Residency: Pediatrics/Emergency Medicine at Emory University Affiliated Hospitals
  • Board Certified in Emergency Medicine
  • Fellow of the American College of Emergency Physicians
  • Fellow of the American College of Certified Wound Specialists
  • Subspecialty Certified Undersea and Hyperbaric Medicine