Just a few days ago we sent you an email with an important report entitled: The Medical Loss Ratio (MLR) Law and How ASH is Doomed. This report is posted on the ACS webpage at  http://www.azchiropractors.org/pages/HEALTH-INSURANCE-LAWS,-ISSUES-AND-LITIGATION.php, Chapter Three.

The federal Medical Loss Ratio (MLR) law requires that insuers spend no more than 15% of revenues (in rare cases 20%) on overhead and profit. According to the reports linked to on the ACS webpage, ASH spends about 50% on overhead and profit. The MLR empowers states to investigate violations of the MLR and report to the federal government for enforcement including refunds. ACS filed complaints with the California Department of Managed Care and just today received a phone call confirming that this powerful oversight agency will be immediately initiating a "non-routine" investigation of ASH' Medical Loss Ratio to see if it is in compliance with the federal law and also to see if it is in compliance with the state MLR, part of the Knox Kimberly Act.

Astute followers of ACS' plans to deal with ASH will recall that Part Four of the original ACS Four Point Plan to Deal With ASH was to gain enforcement of the MLR. Go to http://www.azchiropractors.org/pages/HEALTH-INSURANCE-LAWS,-ISSUES-AND-LITIGATION.php and read Chapter Seven. We now have the California Department of Managed Health Care involved, but we have no intention of stopping there. We intend to get other governmental entities involved as well in investigation and enforcement of the MLR.

ACS completely rejects that approximately 50% of premium dollars spent by policyholders on chiropractic care is being spent on overhead and profit. Far more of this money should and must be spent on patient care. Fortunately, the government has recognized what is right and passed a mandate called the MLR to rectify this situation. ASH will be called to task and ACS will report all developments.

Good morning Senator Gray,

I noted from Dr. Immerman's newsletter that there may be a misperception that I have refused to provide you with the 20 subpoenas you requested. Actually, I am still in the process of preparing the package.  I apologize that I was unable to respond immediately; however, we have a very small staff with a substantial work load.  To date, the subpoenas have been pulled and copied and patient information has been redacted due to confidentially requirements. I have drafted an explanation for each subpoena, and have sent my draft to the Office of the Attorney General for review to make certain that I do not violate any confidentiality laws. I expect to have the package completed by next week and will have it delivered to your office.

Sincerely

Patrice Pritzl

Board of Chiropractic Examiners

Dr. Immerman's Response:

Interesting. I wonder if Director Pritzl really intended to send over the subpoenas before the newsletter was sent out. In any case, they will be very revealing. We all can't wait to see them. It never should have taken her this long to simply make copies of 20 subpoenas. Also, there was no need to redact names since they are all public documents. I believe that is a phony argument and a stall tactic.

ACS has killed the Chiropractic Board's effort to pass legislation which would have given it the authority to raise chiropractor's relicensure fees by an unlimited amount without having to gain the approval of any independent authority such as the Legislature or the Governor's Office. The bill, HB 2111, failed to move out of the Republican Senate Caucus for a vote by the full Senate due to a hold placed by Sen. Linda Gray and so died this year.

The bill had passed the Senate Health Committee by one vote after ACS testified in opposition and the AAC testified that it was neutral on the bill. Then, Sen. Linda Gray demanded that the Board supply the last 20 subpoenas sent out to chiropractors in response to complaints filed. Her intent was to see if the Board is still sending out broad and open-ended subpoenas ("fishing expeditions") in every case or if the Board has begun to comply with the recommendations from the Auditor General to only send out narrow subpoenas pertaining exclusively to the issues raised in the complaint. For example, if the complaint only mentions fees, the Auditor General stated the Board should only subpoena records regarding fees and not also subpoena clinical records such as x-rays and progress notes.

Sen. Gray, a member of the Health Committee, asked Patrice Pritzl, Executive Director of the Board, to supply the 20 subpoenas as part of her investigation. Ms. Pritzl, in a rare act of defiance to a state legislator, refused to comply with the request and instead asked that HB 2111 be pulled from the voting calendar and all further consideration. This was done and the bill is now dead as a result. Clearly, Ms. Pritzl did not want the Legislature to see that the Board has elected to ignore the dictates of the Auditor General and is still routinely sending out broad and open-ended subpoenas in every case and wasting the state's resources.

The AAC, as usual, could not stand up to the Board and just say "no." In the Senate Health Committee, the AAC's position on HB 2111 was "neutral," not "opposed." ACS was opposed. Once again, the AAC proved its deep alliance with the Board. The AAC has never and will never protect the profession from the excesses of the Chiropractic Board. That has been and will continue to be solely the responsibil
ity and mission of ACS. We are very pleased to report victory again this year, and thank Sen. Linda Gray for her part in this achievement. The profession did not need the Board flooded with loads of extra money to hire more investigators to pour over doctors' progress notes, exam forms, x-rays, treatment plans, etc. looking for minor errors to prosecute.

ACS argued to the Legislature that if the Board complied with the Auditor General, it would save so much money that the increase in fees would not be necessary. The fishing expeditions result in the Board unnecessarily combing through scores of doctors' files looking for violations unrelated to the original complaint. Some minor violation is almost always found leading to generation of a new complaint and Board proceedings with disciplinary or non-disciplinary action.

For extensive information about ACS's effort to reform the Board over the past five years, read the information on the webpage devoted to the Chiropractic Board at http://www.azchiropractors.org/pages/ARIZONA-BOARD-OF-CHIROPRACTIC-EXAMINERS.php. Chiropractic Board reform is one of the major missions of ACS.

OPEN LETTER TO AAC ABOUT AAC NEGOTIATIONS WITH ASH AND BCBS

 T. STEVE VAN LAECKEN, D.C. 

Dear AAC Board Members and Members of the Association:

This is exactly why I'm not a member of your association. How long are you going to sing "Let's Kumbaya" with these people while our profession continues to suffer? I think you should join and give support to ACS in this lawsuit effort. The insurance companies will not and have never worked with us on anything. They continue to break the law and you guys just say oh it is ok we will try to live on the table scraps. 

I just had a patient that was under PT for frozen shoulder for 2.5 months and they helped her increase her abduction by 3% in 2.5 months. I saw her 3 times and increased it by 75%.  Guess who the insurance company is going to pay? That is right, the PT and he literally did nothing for her. Guess who did not get paid? That's right, me the chiropractor who helped her BIG TIME. But as far as I'm concerned you, the AAC, have done NOTHING for this profession and continue to be inept when it comes to helping our profession. WAKE up they will NOT negotiate with us PERIOD. Join the fight NOW!!!!!

Our income has dropped by 30% that is what your worthless negotiating has done for our profession... Please stop negotiating you are killing me. If you continue maybe you can drop it another 30%. Do you see I have school loans and bills to pay, I have not been around since the stone ages like most of the AAC board members when I was raping the insurance companies, now I'm paying the price and you couldn't care less. All you are worried about is having the prestige of being a part of the AAC and are so happy to feed off the scraps on the floor while our profession is being strangled illegally. 

So if you DON'T care then keep negotiating so I can finally go get a job at Circle K and you can make your insurance buddies happy and no one will have any chiropractic care at all. You are doing a great job of negotiating all of us out of business. You are as an association INSANE. How's that, well I will define it for you. Doing the same thing over and over again expecting different results = INSANITY. 

Sincerely disgusted and amazed at your lack of effectiveness,

T. Steve Van Laecken, DC. MUAC, DAAMLP

DO YOU WANT HEALTH INSURANCE TO COVER CHIROPRACTIC AGAIN?