I have been a provider for Blue Cross and Blue Shield of Arizona (BCBS) for more than 20 years. At first, they were a premier company, and they allowed patients to seek chiropractic care as an alternative form of treatment. I used to recommend that my patients, if they had the chance, choose BCBS as their insurance company. My advice now is to NOT use BCBS as your insurance company!
My how things change...
About three years ago, BCBS made a strategic, and brilliant move. It was a calculated move with one goal in mind: To eliminate reimbursement by BCBS to chiropractors for treatment, and by so doing, shifting all of the cost to you, the patient.
How did they do it? Let me explain.
First, they did something that I, and many other chiropractors, consider to be illegal. Something so simple, almost flattering, but so vile and damning: They classified all chiropractors as specialists. Ironically, in the state of Arizona, chiropractors are primary care physicians, according to state law, and as such, cannot even advertise themselves as being a specialist of any kind. This seemingly benign move actually increased the co-pay that every patient pays to their chiropractor at the time of visit from about $20 per visit to $45 dollars per visit, or more. If you had insurance through BCBS three years ago, you probably noticed this change.
Since most visits in my office are at or below $50 (that being all that BCBS will allow), once we, as chiropractors, collect your co-pay, the amount due from BCBS is usually close to $0. That is right. In most cases, BCBS is not contributing to help pay for your chiropractic treatment. ZERO.
Now, they advertise that they allow so many chiropractic visits per year. They will tell you and your employer "yes, we cover chiropractic care". You see, these are selling points. Consumers want chiropractic care. They see the value in what we, as alternative medicine practitioners, do. BCBS promises to cover chiropractic care, but in actual administration, pays little or nothing of your office visit.
Chiropractors have battled back over the past few years. First, we tried to pass a new law that would force all insurance companies to not discriminate against non-MD health care providers. BCBS and other insurance companies hired expensive lobbyists to sway the Arizona State House of Representatives in their favor, and our equality bill stalled in the House of Representatives. Legislators told the chiropractors that the current anti-discrimination laws were strong enough, and that the matter should be brought before the Arizona Department of Insurance (ADI) and the state attorney general for enforcement.
Chiropractors asked the ADI to help, and they did nothing. An appeal was then made to the Arizona State Attorney General's office (AG) to render an opinion regarding BCBS alleged illegal discriminatory practices. The AG stonewalled for two long years before making a decision (too busy with political in-fighting and snipe hunts). Finally a decision was handed down after much prodding from the state chiropractors. The AG's office stated that BCBS could call chiropractors "specialists", and force you, the patient, to pay a higher co-pay every visit. Chalk one up for the bad guys, again, and damn you, the consumer, and your rights. Thank you Terry Goddard.
I wish that the story ended here, but it doesn't. The Arizona Chiropractic Society (ACS) has decided to file a lawsuit against the Arizona Department of Insurance (ADI) for failing to uphold insurance equality laws. This will be a costly fight, but I for one believe that it is timely. Many chiropractors are contributing to the legal war chest, and once the funds are in place, ACS will file the suit.
BCBS, on the other hand, has not been sitting by quietly relishing in their victories. I received a letter from BCBS this past month informing me that ASH (American Specialty Health) has been contracted by BCBS to determine medical necessity of all BCBS chiropractic treatment claims. If you have BCBS, you probably got a letter too. The reason given why BCBS is making this change, according to an ASH representative who came to my office, is to reduce chiropractic claim expenses through BCBS by reducing your access to your chiropractor.
Amazing... since my BCBS insured patients are already paying nearly 100% of their own costs for "insured"chiropractic care, how much does BCBS expect to save by further restricting patient access to me, the chiropractor? In reality, such a move will INCREASE costs to BCBS, as more and more patients select the more expensive yet covered benefits of epidural injections, expensive narcotics, spinal surgeries, etc, with all of their medical side effects! Clearly, BCBS believes that the best defense is a good offense.
This is how ASH works. I can see a patient for 5 visits. Then, before the sixth visit, I have to apply for pre-authorization. IF all is in order with my appeal, according to the hired harlots (reviewers... who have sold their souls to save BCBS money) at ASH, perhaps they will authorize one or two more visits...perhaps. (ASH has a track record. The average treatment being deemed "medically necessary" by ASH is 5-8 visits). It doesn't matter if your BCBS Policy allows 20, 50, or even 100 chiropractic visits per year. The most ironic thing about this new ASH contract and their tactics is that you, the BCBS premium payer, is the one that funds them. See how it works? You get less care, doctors don't get paid, and a new middle man, ASH, gets a large piece of the pie. "The pie" is your medical insurance premium. Aren't you glad that you get to pay more money so that more bureaucrats can deny you of benefits? It gives me the warm fuzzies... no wait, that is nausea.
I would like to tell BCBS and ASH what they can do with their claims, with the paperwork, with their heartless treatment of patients, and with their discriminatory practices, but lets just say that it would be anatomically impossible for them to file everything where the "sun doesn't shine..."
Am I mad? YOU BET I AM! If you have BCBS, you should be too. Even though my profession is fighting BCBS and ASH, we cannot do it alone. If you have BCBS, you are probably already paying for all of your chiropractic care with your own co-pay. You might as well join an HMO, obtain better medical coverage, pay less for the coverage, and continue to pay for your chiropractic care out of your own pocket.
On the other hand, you could just sit quietly by and let BCBS get away with their dirty, and in my mind, illegal and discriminatory practices.
SHAME ON BLUE!
Keith E. Biggs, DC
www.eastmesachiropractor.com
biggschiropractic@gmail.com
We here in Flagstaff are aproximately 70% blue cross blue shield of arizona. I know at least two chiropractors going out of business over this bad blue blunder. Anyone with a rational thought has to see the discriminatory actions. Just look how sneaky they have been. Only those that have seen a chiropractor on the arizona network received a letter. Out of state plans never new what was comming. Worse, they are telling a half truth (I would call it a lie). They say they can have ALL the chiropractic they Medically need and that the Chiropractor can do ALL they have been doing before. They don't tell you that ALMOST ALL services are reimbursed lower than it cost to produce them and that 5-8 is ALL that is considered medically neccesary by ASH. GOOD POST! WE ALL NEED TO SPREAD THIS WORD.
ReplyDeleteBruce