March 2004

MCA takes BCBS to court

Blue Cross/Blue Shield (BCBS) is under chiropractic attack again. On March 12, lawyers for the Michigan Chiropractic Association (MCA) took the first legal step to change the discriminatory practices of Blue Cross/Blue Shield by filing a lawsuit in Ingham County Circuit Court.

In the 20-page complaint, the MCA charged that BCBS has interpreted and applied the rules as stated by Public Act 350, the Provider Class Plan, The Physician Participation Agreements and the Subscriber Agreements in a way that “prevents subscribers from getting the care that Blue Cross/Blue Shield advertises is available to them.”

In part, the complaint reads: “Blue Cross, through its reimbursement policies … and the Subscriber Agreements is pursuing policies, interpreting and applying rules and otherwise taking actions which have the consequence of depriving Plaintiff MCA’s members of the amount of reimbursement to which they are entitled and/or which actions cause Plaintiff MCA’s members to refrain from seeking reimbursement for or from undertaking and instead referring elsewhere, services within their scope ... In addition, Blue Cross, through its reimbursement policies … is wrongfully attempting to restrict the methods of diagnosis or treatment of professional health care providers who treat members.

Dr. Ken Hughes, president of the MCA said, “The main goal of the suit is to level the playing field so that chiropractors can take care of their patients based on clinical need and not arbitrary insurance company financial goals.”

Dr. Bill Goss, chairman of Michigan Chiropractic Legal Action Committee (MCLAC) said, “Blue Cross arbitrarily denies claims that are within the scope of accepted treatment, and they are moving toward a model of care that is based on pain instead of accepted objective findings.”

He explained that pain is not the only way to measure whether or not a patient needs care, and that denying coverage for corrective chiropractic because there is no current pain is like “telling a dentist they can’t fill a cavity unless their patient is experiencing pain. If a patient can’t be approved for treatment, their condition will worsen and eventually they may have to have surgery and/or be hospitalized”, he said.

Goss said he’d like to see chiropractors recognized for “their role in the restoration of health and not just relief of pain.”

In the meantime, Goss said, financial support from MCA members continues to be important as legal fees mount. “We also need chiropractors to keep us informed of abuses so we can update the attorneys as the suit continues”

For updates on the case, a copy of the complaint or more information on the lawsuit, visit www.michiganchiropractic.org

Source: Michigan Chiropractic Association, www.michiganchiropractic.org

Industry News from:
Chiropractic News from: