June 2005

ACA takes on insurer-abuse complaints

The American Chiropractic Association (ACA) is launching an aggressive campaign to correct wrongful practice of certain chiropractic managed care networks. The organization has hired the firm of Milberg Weiss, one of the nation’s largest class-action law firms, to assist in collecting and analyzing information on managed-care claim abuse.

The ACA says that over the last three years, hundreds of chiropractors have contacted the ACA and have completed “managed care data collection” forms that detail their complaints with chiropractic networks. The data collected shows that chiropractors are especially troubled by the actions of American Chiropractic Network (CAN), American Specialty Health Plans (ASHP), and Landmark Healthcare.

Among the practices that ACA and the law firm will address are:

• Automatic downcoding or limiting physician care. The doctor submits the network’s forms after examining the patient and is advised of the frequency, duration, and type of care that will be covered on the policy. The insurance company often reduces or denies treatment and downcodes claims without giving the doctor the opportunity to provide any documentation to support the claim as submitted.

• Bundling. The insurance company incorporates the submitted CPT code into another submitted CPT code.

• Improper utilization review. This includes a refusal to recognize coding modifiers. Managed care organizations sometimes refuse to recognize modifiers that chiropractors add onto CPT codes to report a service or procedure that has been performed and has been altered by some specific circumstance.

• Performance management issues. Managed care networks often disregard the doctor’s discretion to diagnose and treat and limit the number of visits, X-rays, and modalities. Doctors claim they are threatened with the loss of their contract when the care they prescribe is outside the managed care organization’s set standards.

ACA President Donald Krippendorf, DC, said, “We have heard your complaints and we are further analyzing our options to deal with these activities.”

ACA is canvassing the chiropractic profession for more data. ACA invites individuals who feel they have experienced problems with CAN, ASHP, and Landmark to fill out the data collection form found on ACA’s Web site, www. Acatoday.com

Source: American Chiropractic Association, www.acatoday.com

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