INSURANCE COMMISSIONER RULES AGAINST BLUE CROSS

INSURANCE COMMISSIONER RULES AGAINST BLUE CROSS
September 24, 2007
Chiroweb.com

In July, Michigan Insurance Commissioner Linda Watters declared that Blue Cross Blue Shield of MichiganÌs (BCBSM) Healthy Blue insurance options were unlawful. The ruling came after the Michigan Association of Chiropractors (MAC) filed a lawsuit against BCBSM, alleging that Healthy Blue policies excluded doctors of chiropractic from performing physical medicine modalities and other services within MichiganÌs chiropractic scope of practice.

Watters ruled that once BCBSM offers coverage for a particular medical service, it cannot exclude a class of providers from being paid for that service, so long as the provider is authorized by law and professional license to administer that service. Watters also stated that Blue Cross could not exclude spinal manipulative therapy from its coverage unless the exclusion equally applied to all provider groups. This means that policies cannot discriminate against one provider group (e.g., chiropractors) while allowing other providers to perform the excluded service.

Finally, she stated that DCs must be treated in the same manner as other providers authorized to provide physical therapy, provided they are permitted by scope and licensure to perform such services. An attorney for Blue Cross has stated that the company will be ÏcorrectingÓ its My Blue policies to conform to the commissionerÌs decision in the Healthy Blue Case.

This victory comes close on the heels of successful negotiations between MAC and Priority Health regarding coverage for Ïphysical medicine services,Ó which would include 30 physical, occupational, chiropractic and osteopathic visits. These benefits would be available with all Priority Health policies, and riders would be available for additional visits. Evaluation & Management services and X-rays would not be limited by the 30 procedures, and chiropractic services would not require a referral or preauthorization. Additionally, all allowable physical and occupational therapy, including services provided within the scope of practice of chiropractic physicians (including spinal manipulation) for treatment of medical diagnoses would be covered if due to an injury, illness or a congenital defect.

According to MAC President Kirk Steketee, DC, ÏThese wins send a very strong message to Michigan insurers. Doctors of chiropractic will continue to fight for our right to practice and the rights of our patients to receive chiropractic treatment.Ó However, he cautioned, ÏWhile these victories are extremely important, they are just the first step. We will continue to explore every option in ending discrimination against chiropractic in all health plans.Ó