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Welcome to the Chiropractic Networks Action Center, where you can read the latest news about efforts on both the national and state levels to correct the wrongful practices of certain chiropractic managed care networks, and speak up on behalf of chiropractors everywhere.
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Contact: 1(800)986-4636
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Through the information ACA receives from our members we are able to inform different departments of insurance and other regulatory agencies of the practices of chiropractic networks and the effects those networks have on patient care. Transmitting this information to departments of insurance is important because different departments of insurance have the authority to impose fines on insurers for state law violations.
ACA has been in the process of collecting data for use by regulators in the form of non-sanitized patient health records from providers whose patients have been affected by the practices of chiropractic networks. Complete patient health records allow regulatory authorities to follow the role the patient’s insurance coverage played in the care the patient received. Full patient health records also allow regulatory agencies to see the repetitive actions of chiropractic networks which, in our view, do not seem to take into account patients’ individual needs based on variances in comorbidity/diagnosis combinations. To read more about this effort visit: www.acatoday.org/datacollection
The ACA understands just how busy our members are and that some providers may not have the time to copy and submit full copies of patient health records. Because of this, we have worked to develop an easy and efficient method for providers to collect patient information regarding chiropractic networks. The ACA has a Patient Benefits Questionnaire that we would like providers to make available for their patients. This questionnaire seeks to obtain, straight from the patient, their thoughts regarding the management of their chiropractic benefit. This questionnaire also allows patients to volunteer to speak directly to regulators, if they would like to voice their concerns. The Patient Benefits Questionnaire is available here and the ACA encourages providers to print copies of this document, provide them to patients, and fax the completed questionnaires to the ACA at: 1-866-575-8615. To read more about ACA’s recent activity, please review the Summer Update below and join your colleagues in reporting the practices of insurers and networks whose policies may not take into account your patient’s needs.
| Summer 2008 Update |
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While the national class action suit, which resulted in settlements with Humana and CIGNA, was recently dismissed against United HealthCare (UHC) and ACN, we continue to fight on other fronts to end, what we view are, unfair practices by chiropractic networks. In recent months,UHC, ACN’s parent company, has received an increasing amount of media attention regarding their wide expansion and their business practices. In the state of Nevada, the Attorney General (AG) and the Department of Justice (DOJ) stepped in after UHC had acquired another company in the state. The AG and the DOJ alleged that United Health Group, incorporated, may be violating federal and state antitrust laws and reducing competition in the market for all Medicare Advantage products in the Las Vegas area. Concerns of a healthcare analyst regarding the rate at which UHC has expanded and how the quality of the management of their companies may have decreased were also discussed in a recent New York Times article. Because UHC is getting additional attention from state regulators and the media, it is increasingly important for doctors to share their experiences and concerns regarding UHC and ACN with their Departments of Insurance and with their Attorneys General. The ACA continues to meet with these regulatory authorities and, to make our meetings effective, the regulators have to see evidence from individuals within their states.
In the eastern United States, the ACA, in response to a specific request by state regulators, has been encouraging doctors to submit documentation regarding their treatment by certain companies when providing services out of network. These requests for information came as a result of the attention that certain insurers received from the New York Attorney General regarding their use of Ingenix' claims data to determine reimbursement practices.
The New York Attorney General has also been instrumental in drawing attention to provider rating systems that many insurers are trying to put into place. In late 2007 and early 2008, insurer representatives and the New York Attorney General worked together to develop certain requirements for physician rating systems. In an effort to provide transparency and accountability, the National Committee for Quality Assurance (NCQA) recently launched a web site that allows users to review the new requirements of the rating systems and to determine if the insurers are working in compliance with those requirements. Read more about this new web site here and review how different health plans are doing by clicking here. To ensure that patients are receiving rating information that truly takes into consideration quality healthcare and not simply cost, this sort of monitoring is essential. The American Medical Association has also recognized this need and has published principles and guidelines for pay for performance programs. Providers need to understand the strong role that Departments of Insurance and state Attorneys General can play in monitoring the actions of insurers. Please take the time to submit documentation to the ACA regarding the practices of chiropractic networks in your state.
Please visit www.acatoday.org/appeals to begin working to correct, what we believe are inappropriate practices of chiropractic networks.
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