It’s who you know
by Communications Staff
August 31, 2010 — A litigator at firms in Seattle and DC before joining the American Psychological Association (APA) Practice Directorate in 2000, Alan Nessman, JD, “found it a nice change to be around psychologists instead of lawyers all day.” In nice weather, he enjoys biking to work from his home in Washington, DC to a job he praises as “always intellectually challenging because there is always a new issue to analyze or problem to solve. We have to be creative because we are trying to accomplish so much.”
He likes that “We’re helping members with difficult legal issues so that they can focus on helping their patients.”
An attorney with 26 years of experience, Alan serves as Senior Special Counsel in the Practice Directorate’s Legal and Regulatory Affairs (LRA) department.
His work on behalf of members falls into three main categories
Advocacy on behalf of members, such as class action lawsuits targeting managed care abuses
Compliance and guidance resources for members on issues such as the Health Insurance Portability and Accountability Act (HIPAA), anti-trust, insurance and managed care
In addition, he works on other projects such as one in the Washington, DC, courts where psychologists provide parenting coordination services to indigent families embroiled in child custody disputes.
Examples of issues that fall into the three categories, and Alan’s work on each, are outlined here.
Alan has been involved in the Practice Directorate’s seven major lawsuits against most of the nation’s largest health insurers. In settlement of a class action litigation in Florida that alleged wrongful manipulation of billing codes, insurer CIGNA paid out over $2 million to 4,000 psychologists, and the company agreed to an array of policy changes that benefitted members. Other lawsuits focused on harm to psychologists and patient access to care caused by a large rate cut, false advertising of mental health benefits, “no-cause” termination of network psychologists, and intrusion on patient privacy from aggressive case management.
The major current lawsuits are three nationwide class actions against major insurers alleging that the companies used UnitedHealthcare’s faulty Ingenix database to suppress out-of-network reimbursement to psychologists.
In these class action lawsuits, Alan explains, “We guide members through the process for submitting claims to the settlement fund, as we did with United’s recent $350 million settlement. We took a complicated 15-page, small print settlement notice and translated it into what our members need to do to submit a claim.”
“Lawsuits are high profile and have given us great results, but often we need faster action in advocating for our members.” As an example, Alan notes that a major insurer in the New York City metropolitan area was demanding refunds of tens of thousands of dollars from members based on claims of inadequate records. The members affected by this demand could not wait for the matter to drag through the courts. “So we drafted a strong letter outlining the many ways that the refund demands violated the law, and we were ready to sue if necessary. Fortunately, the company saw the light and backed off of its demands.”
Alan’s advocacy work on behalf of professional psychology also includes collaborating with other directorate staff in arguing for greater privacy protections in regulations promulgated under the Health Information Technology for Economic and Clinical Health (HITECH) Act. This includes presenting arguments to the federal government on why and how psychological test data should receive heightened protection.
Along with his department colleagues, Alan reviews complex laws and regulations designed for hospital chains and other large health care entities that have a team of lawyers and consultants. “We figure out what they mean and how they apply to our members’ small practices, and translate them into plain English. We also try to develop tools that make compliance as painless as possible.”
Nessman was a key developer of the APAPO’s compliance products tailored for psychologists regarding the HIPAA Privacy Rule and Security Rule. He is currently working on updating these compliance resources to reflect recent changes to HIPAA under the HITECH Act.
Nessman enjoys the challenge of figuring out how HIPAA and patient privacy, subpoena, insurance, anti-trust, parity and record keeping laws and guidance apply to a member’s particular circumstance. “We try to provide members with general guidance covering typical situations they will encounter. But applying the laws to the unique circumstances facing a member often requires going through a complex analysis from scratch.”
“Most members understand that we can’t give them legal advice or legal opinions. They need to consult a private attorney with appropriate experience for that. But we give them our view of the laws and regulations and direct them to resources such as state licensing boards or their malpractice carrier.”
Alan finds the variety and complexity of his job rewarding. “Talking to members keeps us in touch with their professional needs and concerns. And it reminds me why we work so hard.”
Members with questions about the activities mentioned in this article may contact Mr. Nessman by e-mail or call 202-336-5886.