PRIVATE PRACTICE - Fighting for Your Patients: Best Practices to Reverse Insurance Coverage and Payment Denials

Craig is the Chief Operations Officer at Therapy Partners, Inc., where he directs internal operations and support services to 16 practices with 34 locations in Minnesota and Wisconsin. He supports member practice solutions with a focus on care management, outcomes management, value-based contracting, compliance, and reimbursement. He has over 40 years in clinical care, practice ownership, and management in independent therapy practices.

His professional degrees include a Physical Therapy degree from the University of Minnesota, 1979; and MBA from University of St. Thomas, 2000. 

Bob Hall works for the Private Practice Section by serving as the Senior Consultant handling payment issues. He helps health professionals maximize their collective impact as Executive Chair of a solo consulting firm focused on improving access to quality, affordable health care. From 2016-2018, Bob was the Director of Government Relations at the American Academy of Family Physicians. Bob directed all legislative and regulatory advocacy for the AAFP, including changes to the Medicare fee schedule’s treatment of primary care and oversight of the Academy's Center for State Policy. Bob was also elected to represent AAFP as the first Co-Chair of the Partnership for Medicaid, a nonpartisan, nationwide coalition made up of 23 organizations representing doctors, health care providers, safety net health plans, counties, and labor. Bob spearheaded the access to care portfolio at the American Academy of Pediatrics from 2006-2016, leading efforts to improve insurance coverage for children. Prior to his tenure at AAP, he served as Director of Government Relations for the National Coalition for Cancer Survivorship, Counsel to US Senator Mark Dayton, Attorney Advisor to the US Securities and Exchange Commission and Chief Clerk to the Texas House of Representatives Insurance Committee. He holds a Masters in Public Affairs from the LBJ School of Public Affairs, a Juris Doctor from the University of Texas School of Law and a BA from Haverford College.

Gwen Simons, Esq, PT, OCS, FAAOMPT is a healthcare lawyer at Simons & Associates Law in Scarborough, Maine. Her law firm caters to the needs of health care providers in private practice, representing providers in contract negotiations/disputes with payers and providing Medicare/HIPAA compliance and practice management consultation. She’s also been a fearless advocate for physical therapy issues, taking on the Goliath insurance carriers on prior authorization, payment, unfair contracting issues in Maine’s state legislature as the Maine Chapter APTA’s lobbyist. She has served on several PPS and AOPT Task forces on payment issues and is the 2023 recipient of the Maine Chapter’s President’s Service Award for her advocacy work to pass Maine legislation to prohibit insurance carrier prior authorization requirements before visit 12.