EXPLAINING THE COUNTS IN THE ACS ADOI LAWSUIT
The 13 page lawsuit against the Arizona Department of Insurance (ADOI) is complicated to read and decipher and so we thought we would distill the key points down to a few paragraphs for you. Now you be able to clearly see how valuable this lawsuit is to the survival of chiropractic, the welfare of your patients, and your practice. Here is a brief explanation of each of the counts in the ACS ADOI Lawsuit. The case number is CV2011-093099 and you can track the progress online through the Maricopa County Superior Court system at http://www.superiorcourt.maricopa.gov/docket/CivilCourtCases/
The future of health insurance coverage for chiropractic in Arizona depends on the outcome of this lawsuit. John A. Amaro D.C., President of the International Academy of Medical Acupuncture and a 30 year Arizona resident, wrote the following letter dated 03/07/11 to ACS:
Alan, you possess what it will take to save this profession. I am humbled by your dedication, intelligence, drive, persistence and passion. There are unfortunately very few of you in our profession in a leadership capacity. You are in a definite league of your own and your ability to surround yourself with dedicated doctors is legendary. All the very best my friend you are to be admired as are the doctors who have heeded your call. John
Failing to prohibit insurers from applying copayments and deductibles in a manner that does not discriminate against the usual and customary treatment procedures of chiropractors. BCBS has defended this practice in the past by stating that chiropractors are specialists and so the specialist copay rightfully applies, but now BCBS no longer categorizes chiropractors as specialists and so this defense no longer applies. ACS is demanding that copays and deductibles for chiropractors be set at PCP levels.
Failing to require insurers to apply cost containment measures, in this case preauthorization, equally to MDs, DOs and DCs. Under ASH, DCs must get preauthorization to treat patients. BCBS does not require MDs and DOs to get preauthorization to treat the same patients.
Approving BCBS's retention of American Specialty Health (ASH) even though ADOI knows, or should know, that ASH has a long history of not covering all reasonable and necessary chiropractic care including the total number of necessary visits and the total number of services per visit.
Approving BCBS insurance policies which have
exclusions that apply only to chiropractic care but not to care rendered by MDs and DOs. This results in no coverage for chiropractic care of chronic pain patients whose function is not expected to improve, whereas there is coverage for MD and DO care of such patients.
Allowing BCBS to engage in consumer fraud by advertising that it covers all medically necessary chiropractic care but then paying only $4 of a total visit reimbursement amount of usually $44 ($26 for a spinal manipulation and $18 for physical medicine). This is an illusory benefit that deceives the public and defrauds BCBS' customers.
Failing to prohibit BCBS from creating designations such as specialist, PCP and chiropractor for copay and deductible purposes that do not discriminate against the usual and customary procedures of chiropractors. The current designations do create this exact form of discrimination.
When we win, health insurance coverage for chiropractic will be fully restored in Arizona. 300 Arizona chiropractors have determined that is a cause worth investing in with their ACS dues and $500 lawsuit donation checks. More doctors are joining and donating all the time. This is the cause to support, and now is the time.