July 2004

Michigan DCs file suit against BCBS

The Michigan Chiropractic Association has filed a lawsuit against Blue Cross Blue Shield because of its payment policies. And according to a survey released by the MCA, approximately 30 percent of Michigan chiropractors are practicing in fear of disaffiliation from the network if they didn’t provide less care than was allowed in a patient’s insurance policy.

The MCA says that most BCBS policies agree to pay for 24 chiropractic visits per year, but doctors who average 12 visits are considered “over-utilizers” and are at risk of disaffiliation, MCA president Dr. Ken Hughes told Chiropractic Economics. About 81 percent of the doctors surveyed believe that practices of the American Chiropractic Network (ACN), an agent of BCBS, are part of a cost-cutting campaign meant to exclude patients from receiving the chiropractic coverage that is promised in their insurance policy.

BCBS contends that the lawsuit focuses on doctors and their reimbursements but chiropractors state that it is patients who ultimately lose because of BCBS practices. Chiropractors strongly assert that if left unchecked, patient coverage will not adequately serve the health interests of Michigan residents. “Blue Cross Blue Shield’s reimbursement protocol is based on old-fashioned statistical analysis instead of modern chiropractic clinical guidelines,” Hughes said.

MCA has posted its formal complaint against BCBS on its Web site.

Source: Michigan Chiropractic Association, www.michiganchiropractic.org.

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