On June 23, I participated in a meeting that illustrates how the Washington State Chiropractic Association (WSCA) and Washington State Chiropractic Trust (WSCT) are working hard to protect the chiropractic profession in our state.
The WSCA and the WCT, along with State Rep. Eileen Cody, Chair of the House Health Care Committee, met with insurance company representatives to discuss three critical issues affecting our state’s chiropractors:
- Copays that exceed the allowed amount paid to a chiropractor.
- Fee schedules that have not increased in more than a decade and disparate pay for chiropractic manipulation services vs. osteopaths and naturopaths (paid nearly 100% more in many cases).
- Prior authorization requirements with no rational clinical basis that only serve to disrupt or prevent necessary care and burden providers with unmanageable administrative struggles.
While all insurers were invited, those attending included Regence, Premera, Molina, Group Health and Aetna, along with one representative from the Association Health Plans. Our attendees included WSCA President Garry Baldwin, DC; WSCA Executive Director/Lobbyist Lori Grassi; Austin McMillin, DC and myself.
Rep. Cody opened the meeting by asking insurers to consider that their current copay practices may be creating deterrents to patients following their treatment plans and could be adding to the opioid epidemic, forcing patients to turn to drugs when they are in chronic pain.
Lori Grassi prepared materials to illustrate the disparate payments between professions for virtually the same service. The WSCA attendees provided excellent examples of the discriminatory behavior that insurers are applying to chiropractors.
Dr. McMillin led a remarkable conversation about the development of the CPT codes and how the Relative Value Units (RVUs) are intended to apply regardless of provider type to all services described by a CPT code. He delivered a historical perspective that stifled the insurance representatives and left the room silent.
Compelling examples were provided of why the prior authorization process is arbitrary, non-clinical, disrupts and denies care and benefits.
The meeting can be summarized in these bullet points:
- The pay to chiropractors is blatantly unfair and discriminatory, and insurers are using arbitrary methods for establishing chiropractor fee schedules.
- Between prior authorization requirements and menial payment for manipulation – whether the payment is a copay paid entirely by the patient or the minimal “allowed amount” actually paid by an insurer – it doesn’t cover the cost of the administrative work shifted to the provider along with providing the care.
- The WSCA will likely need to run a bill again to overcome this inequity and we will need strong support from the profession to move the issue through the process.
We will also be meeting with the Office of the Insurance Commissioner on June 30, 2016, to discuss detailed issues regarding the prior-authorization processes used to deny access to chiropractic care.
These are just a couple of ways that the WSCA and WSCT are working to protect the chiropractic profession in Washington State. If you are a regular contributor to the WSCT, thank you. If not, I urge you to do so today!
You can click here to make a one-time or recurring donation online. Or you can mail your donation to WSCT, PO Box 2163, Seattle, WA 98111
Consider a one-time contribution: $1000, $500, $250, $100 or sign up for monthly credit card withdrawals: $100, $50, $25 monthly.
— Dr. Dave Butters, President
Washington State Chiropractic Trust