The California Department of Managed Health Care has just released a formal letter documenting that it has initiated a "non-routine" investigation into American Specialty Health (ASH) regarding possible violations of the state Medical Loss Ratio (MLR) law. To read the letter, go to www.AZChiropractors.org and scroll down to the section on Breaking News.

     ASH is a subsidiary of ASHN which is a licensee of the California Department of Managed Care and so subject to the state MLR. This law requires plans including ASH to spend at least 85% (in special circumstances 75%) of revenues on patient care, and no more than 15% (special cases 25%) on overhead and profit.

     According to ASH financial statements which are posted on the ACS webpage next to the California letter, the ASH MLR is approximately 50% which appears to be a clear violation of the California MLR. It is for this reason that a "non-routine" investigation was launched immediately upon receipt of complaints from ACS.

     The outcome of the investigation will be reported by ACS as soon as it becomes available. It appears inevitable that ASH will be found in serious violation and ordered to pay fines and refunds.

     To inform you about the MLR, ACS has written an article 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, #3.

     When ASH is forced to spend no more than 15% to 25% on overhead and profit instead of the current 50%, much more money will be available to pay to doctors for their services rather than to the many "babysitters" hired to oversee the treatment of every chiropractic patient. This is as it should be.

     It is wrong that 50% of premium dollars is being spent on overhead and profit and not patient care, and this is why laws were passed to ban such outrageous percentages. Much more of this money must and will be spent on patient care thanks to the complaints filed by ACS and the upcoming enforcement action by the California Department of Managed Care. ASH will be unrecognizable when it can only spend 15% rather than 50% on overhead and profit. Prepare for major change, brought to you by ACS. If you are not a member, please join or donate to continue to make this work possible.

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?