Do you believe you have been reimbursed unfairly for a service by a group health plan or health insurer based on your license?
The American Chiropractic Association (ACA) seeks examples of this practice to share with the Biden Administration as evidence that the provider nondiscrimination provision outlined in Section 2706(a) of the Patient Protection and Affordable Care Act is not enforced.
This is a critical issue to all chiropractors and the entire non-MD community. ACA is working closely with the Patient Access to Responsible Care Alliance (PARCA), a group of non-MD associations, to get federal regulators to enforce Section 2706 and ensure fair patient access and provider reimbursement. ACA has posted a dedicated 2706(a) section on its website, where doctors of chiropractic (DCs) can share personal stories about how patients have had access limited or chiropractors may have been compensated unfairly by a group health plan or health insurer. The page includes a form that you can use to submit your experiences with provider discrimination.
Your personal stories will be vital to our advocacy efforts. Learn more about ACA’s activity and analysis on this issue, and access the reporting form, at www.acatoday.org/advocacy/competitive-health-insurance-reform-act/.
Section 2706(a) of the Affordable Care Act prohibits health insurers from engaging in discriminatory access and reimbursement practices by paying different payment rates to certain medical providers over others. The recently enacted “No Surprises Act” included an ACA-supported provision to require federal agencies to promulgate a regulation to enforce Section 2706. Federal agencies will be releasing a proposed rule, with a public comment period sometime in the near future.
The PARCA coalition submitted a letter to federal regulators in March urging them to enforce a rule that requires group health plans and health insurers to fairly compensate non-MDs for the same services delivered by other healthcare providers. The letter is addressed to the secretaries of the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury.
The PARCA letter includes just one example of how chiropractors can fall prey to unscrupulous coverage policies:
“Payers are changing policies to bundle services in preparation for moving away from fee for service, however, rather than create a combined fee, they simply eliminate one fee and pay for the other. This is not in keeping with the calculation of relative values. In other words, chiropractic manipulative treatment may be bundled with manual therapy and providers have been notified that no reimbursement will be made for manual therapy whatsoever when these services are performed together, regardless of the modifier used. These limitations are not applied to other provider types.”
With the chiropractic profession’s help, ACA intends to highlight specific examples of payment discrimination against DCs to federal regulators, so please share your experiences with us. We will continue to work with PARCA and other allies to secure fair patient coverage and provider reimbursement.
Steve Kline is ACA’s associate director of federal government relations. He can be reached at firstname.lastname@example.org.