Insurance News

(Reprinted from the ACA “Week In Review” of 10/28/2010) You may recently have heard about United Healthcare (UHC) and another flawed policy proffered by this carrier. Like you, we at ACA are not at all happy about it. This unfortunate policy, which offers definitions of “essential, mixed, and non-essential benefits” --chiropractic is listed as non-essential--is just another attempt to jockey around impending non-discrimination mandates. We are developing an appropriate response along with our Chiropractic Summit partners so our message is unified and our actions are focused and effective. We will share the response with you once it is available.

           The Insurance Journal reported the following on August 11th: “The National Insurance Crime Bureau (NICB) announced today that it has established its second major medical fraud task force in Florida to counter the increase and spread in acts of medical fraud.”

            Florida CFO Alex Sink announced the acquisition of a new investigative tool for the Division of Insurance Fraud (DIF) to use when investigating insurance fraud crime. The Division is introducing a surveillance vehicle that will assist detectives in undercover and long-term, complex operations. Investigative tools like this offer detectives enhanced surveillance opportunities and provide an invaluable asset to investigators that directly affect investigative efforts.

JUDGE DENIES BLUE CROSS’ ATTEMPT TO DISMISS ERISA AND FLORIDA INSURANCE EQUALITY LAW CLASS ACTION

      The Florida Chiropractic Association and FCA Member Peri Dwyer, D.C., through Class Counsel and FCA Assistant General Counsel Kim Driggers of the law firm of Brooks, LeBoeuf, Bennett, Foster & Gwartney, joined 18 individual plaintiffs and four other chiropractic associations in a class action against 22 leading Blue Cross Blue Shield (“BCBS”) insurers across the country.  The suit challenges BCBS’ abusive practices in using post-payment audits and reviews and improper payment demands, to pressure providers to repay substantial sums that BCBS previously paid as health insurance benefits for services provided to BCBS subscribers.  The suit also seeks damages and an order requiring Blue Cross Blue Shield of Florida (“BCBSF”) to cease violating Florida’s Insurance Equality Laws.  The Complaint alleges BCBSF violated Florida’s Insurance Equality Laws by limiting coverage for certain chiropractic services by covering only a single physical modality or procedure code per patient per day and limiting the number of spinal manipulations that are covered in a calendar year.

The following are important excerpts from the American Chiropractic Association’s latest update on Health Care Reform, issued today.  Remember to stay alert and make your patients aware of their opportunity to influence health care reform legislation by enrolling at www.chirovoice.org. 

Ross Letter in Support of Provider Non-Discrimination Garners Additional Support in U.S. House

Speaker Pelosi Unveils Merged House Bill – Ross Amendment and Public Plan with Negotiated Rates Included -- House Floor Action Predicted by Mid-November

House Bill also Includes Insurance Industry Anti-Trust Reform

Bill Introduced in the House to Address Medicare Payment System

Harkin Provider Non-Discrimination Provision to be Preserved in Blended Senate Bill 

Support for CHIROVOICE and CHAMP Needed

Become a Chiropractic CHAMPion

Watch Health Reform Updates on Your Computer via YouTube 

               The Florida Chiropractic Association has retained class counsel to pursue litigation in the Illinois class action suit vs. Blue Cross Blue Shield Association.  The FCA joins with three other state associations – the Pennsylvania Chiropractic Association, New York Chiropractic Council and the Association of New Jersey Chiropractors – to challenge the Defendants’ abusive practices in using post-payment audits and reviews, and improper repayment demands, to pressure providers to repay substantial sums that have previously properly been paid as health insurance benefits for services provided to BCBS subscribers.  Below is a news release provided by class counsel – Pomerantz Haudek Grossman & Gross LLP – to initially announce the litigation on September 10, 2009 (“Health Care Providers and Associations Sue Blue Cross Blue Shield Association and 22 Related BCBS Entities”). 

               (From an ACA Legislative Alert dated October 14, 2009 at 4:36pm) Please be advised that Representative Mike Ross (D-Arkansas) prominent leader of the House “Blue Dog” Coalition of centrist Democrats, is sending a letter to House Speaker Nancy Pelosi, urging that the final version of national health reform legislation to be brought to the floor of the U.S. House for a vote, retain an amendment agreed to in the House Energy & Commerce Committee that seeks to preserve the applicability of state enacted provider non-discrimination laws favorable to chiropractic and other non-MD providers.

               The “Ross Amendment” states:

               The Florida Chiropractic Association is considering joining a class action against Blue Cross Blue Shield of Florida and other BCBS entities to challenge the manner in which it has conducted post-payment audits and imposed withholds after demanding repayments. As part of this effort, we are investigating how our members have been adversely affected by these practices. Please contact the FCA Assistant General Counsel if: