Time to file Prior Authorization Complaints with Office of Insurance Commissioner


fotolia_106949987This summer the Office of the Insurance Commissioner (OIC) will be preparing Rules (Washington Administrative Code) for the prior authorization of health care services. Engrossed Second Substitute House Bill 1471 which was passed through the efforts of the Washington State Chiropractic Association (WSCA) and Washington State Chiropractic Trust (WSCT), addresses some aspects of prior authorization and will go into effect January 1, 2017. (Read more about the bill at this link: http://1.usa.gov/20D8IBP)

Washington State Chiropractors and their patients can help guide this policy by making comments to the OIC about the problems associated with prior authorization including the filing of complaints with the state agency (OIC) whether on your own or through your patients.

Many of you have been providing comment and anecdotes to the WSCA directly and we encourage you to continue to do so. This is great and we can use the detail in our meetings with legislators and the OIC. In addition to reporting these issues to the WSCA, we need you and your patients to make complaints to the Office of the Insurance Commissioner directly! The link is: http://1.usa.gov/1WY4Ey5

You should:

  1. Write a brief report outlining the patient’s condition, treatment goals, recommendations, complications and consequences of inadequate care; and
  1. Explain that the insurer or its contracted entity (such as Evicore) is denying or delaying benefits that the patient has purchased. Their limits and denials of care cause the patient additional risk of poor health outcomes; and
  1. The insurer or its contracted entity are not using individual clinical information as their basis for authorization or denying care; and
  1. The online system for filing prior authorization requests are inadequate and only allow for one patient diagnosis, which is unrealistic and not clinical. They appear to be computer generated!
  1. When filing complaints REDACT all patient identifying information unless your patient has given you written permission to file the complaint on their behalf.
  1. Be clear in your complaint — if you know that there is a violation of law or rule, make that citation known! It does not require a citation, but if you KNOW there is one, use it to help support your claim.

Example: Issuer (name the insurance company) required my patient to obtain a referral for chiropractic care- RCW 48.43.510 (5) says:  “Each carrier shall provide enrollees with direct access to the participating chiropractor of the enrollee’s choice for covered chiropractic health care without the necessity of prior referral. Nothing in this subsection shall prevent carriers from restricting enrollees to seeing only providers who have signed participating provider agreements or from utilizing other managed care and cost containment techniques and processes. For purposes of this subsection, “covered chiropractic health care” means covered benefits and limitations related to chiropractic health services as stated in the plan’s medical coverage agreement, with the exception of any provisions related to prior referral for services.”

  1. Continue to copy the WSCA on your complaints! Email Lori Grass at LGrassi@chirohealth.org or mail to the WSCA, Attn: Lori Grassi, 21400 International Blvd., Ste. 207, SeaTac, WA 98198

Prior Authorization of health care services is interrupting both the doctor-patient relationship and medically necessary care. There are still issues that need to be addressed regarding prior authorization of health care services and your comments on the record will support strong policy for the WSCA and WSCT to work on your behalf.

Finally, we need your ongoing support to continue the work of the WSCT. If you are a regular contributor to the WSCT, THANK YOU! If not, I urge you to do so today!

Just click here to make a one-time or recurring donation. Or you can mail your donation to 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.

 

From Dr. Butters: I need your help this summer


Butters
Dr. Dave Butters

Memorial Day officially kicks off the summer and some time to relax with family and friends. Aside from this summer’s fun we need you to set aside some time for an important task that will directly impact your profession: networking with your state legislators. Doesn’t Sound Fun? Be Part of the Solution and Do It Anyway!

Invite your lawmakers to coffee or lunch, or to visit your office. It is up to us to educate our legislators about the roadblocks that insurance companies put in our way as we try to care for our patients. Help us to be successful in the 2017 legislative session! Lori Grassi, Executive Director and Lobbyist for the WSCA, is happy to help you coordinate a meeting with your legislators. Don’t hesitate to call her at 206-878-6055 if you need some help or coaching.

This is a major election year, and we have to raise significant $$$$ to effectively contribute to State Senate and House campaigns and House and Senate soft money PACs. Please help us achieve our GOAL OF $120,000 by the November election so we can maintain current legislative relationships and build new ones on both the Democratic and Republican sides of the aisle. Bipartisan support is critical!

The WSCT builds and maintains strong grass roots legislative relationships, and we’ve been doing it for a long time. We support people in both parties who support us. We are the only Chiropractic Political Committee in Washington State.

The WSCA provides our Lobbyist, who coordinates legislative lobby activities and works on state policy and governmental issues affecting the Chiropractic profession in our state.

If you are a regular contributor to the WSCT, THANK YOU! If not, I urge you to do so today!
Just click here to make a one-time or recurring donation.  Or, mail your contribution to 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.

Please help us protect and promote patient access to chiropractic care.

— Dr. Dave Butters, President
Washington State Chiropractic Trust

 

From Dr. Butters: We must focus on political business at home


Butters
David Butters, DC

As many of you have likely noticed, 2016 has been a political season like no other. And although most of the attention has been focused on campaigns for U.S. president, it’s important to remember that as chiropractors, we have very important political business here at home: Elections this fall for Washington State Senate and House seats.

Our hope for success during the 2017 legislative session is directly tied to an abundant continuous flow of resources to effectively contribute to State Senate and House campaigns and House and Senate soft money PACs. We have to maintain our current legislative relationships and build new ones on both the Democratic and Republican sides of the aisle. We must have bipartisan support for our issues!

Your state representatives and senators are making public policy decisions that affect you every day, including access to health care services. We need to ensure that we set the stage now for the 2017 legislative session, by working hard raising money and helping re-elect our chiropractic friends and developing new ones in the November 2016 election.

As I mentioned in my last letter, with the mounting pressure of SICK CARE costs and resulting insurance premium increases. the legislative battles over reimbursement are intense. This creates challenge and opportunity for us. Co-pays often exceed the allowable charge for our services, osteopaths are reimbursed up to 100 percent more for spinal manipulation than we are under a different set of codes that describe the same services, prior authorization requirements that waste time, disrupt care, prevent best practice and best outcomes and ridiculous visit benefit limits. The evidence that we provide best practice, best outcomes, lowest cost and highest patient satisfaction is indisputable (but ignored).

If you have contributed recently and/or are a regular contributor to the WSCT, it is appreciated and makes a difference. If you haven’t contributed, I urge you to do so today. You can click here to make either a one-time or recurring donation online. Or, if you prefer, you can mail your donation to: WSCT, PO Box 2163, Seattle, WA 98111.

Make a one-time contribution: $1000, $500, $250, $100

Sign up for monthly credit card withdrawals: $100, $50, $25 Monthly

— David Butters, DC
WSCT President

Time to fill the chiropractic war chest for November elections


Butters
Dr. Dave Butters

The 2016 session of the Washington State Legislature is over, now it’s all about the 2017 session. No, it’s really about the elections this fall and setting ourselves up to be successful in the 2017 session.

I have been doing this chiropractic political stuff for a long time, but I can’t do any of it without your help. Our hope for success is directly tied to an abundant continuous flow of resources to effectively contribute to State Senate and House campaigns and House and Senate soft money PACs. We have to maintain our current legislative relationships and build new ones on both the Democratic and Republican sides of the aisle. We must have bipartisan support for our issues!

During the short 60-day legislative session, lawmakers were distracted by many priorities – mostly
related to education funding – while we didn’t lose ground we didn’t gain any either. We don’t generally have our best time in short sessions. That’s why it’s extremely important to set the stage for the 2017 five-month session, by working hard raising money and helping re-elect our chiropractic friends and developing new ones in the November 2016 election.

Our Issues of Concern:

With the mounting pressure of SICK CARE costs and resulting insurance premium increases the
legislative battles over reimbursement are intense. This creates challenge and opportunity for us. Copays often exceed the allowable charge for our services, osteopaths are reimbursed up to 100 percent more for spinal manipulation than we are under a different set of codes that describe the same services, prior authorization requirements that waste time, disrupt care, prevent best practice and best outcomes and ridiculous visit benefit limits. The evidence that we provide best practice, best outcomes, lowest cost and highest patient satisfaction is indisputable (but ignored).

If you have contributed recently and/or are a regular contributor to the WSCT, it is appreciated and
makes a difference. If you haven’t contributed, I urge you to do so today.  Just click here to make
either a one-time or recurring donation. Or you can mail your donation to WSCT, PO Box 2163, Seattle, WA 98111.

Make a one-time contribution: $1000, $500, $250 or $100, or sign up for monthly credit card withdrawals of $100, $50 or $25 monthly.

— Dr. Dave Butters, President, Washington State Chiropractic Trust

Chiropractors meet in Olympia for Legislative Day


State chiropractors met in Olympia Feb. 4 for the annul Chiropractic Legislative Day -- a chance to educate state senators and representatives on issues of importance to the chiropractic profession.
State chiropractors met in Olympia Feb. 4 for the annul Chiropractic Legislative Day — a chance to educate state senators and representatives on issues of importance to the chiropractic profession.
Washington State Chiropractic Association lobbyist Lori Grassi updates chiropractors on messages they should be discussing with lawmakers.
Washington State Chiropractic Association lobbyist Lori Grassi updates chiropractors on messages they should be discussing with lawmakers.

Our 2016 Chiropractic Legislative Agenda — and mark your calendar for Legislative Day Feb. 4


Dr. Dave Butters
Dr. Dave Butters

Here is the 2016 Legislative Agenda as approved by the Washington State Chiropractic Trust (WSCT) and the Washington State Chiropractic Association Board (WSCA):

 

Inclusion of Chiropractors in Medicaid for Adults

The spinal manipulation benefits for adult Medicaid recipients in Washington State is limited to 10 visits, but those visits can only be delivered by osteopaths and naturopaths. The WSCA challenged this policy with the Washington State Health Care Authority, the state agency that manages Medicaid eligibility and benefits, and was told that the benefit was not funded adequately to allow chiropractors to deliver the care. This means we need to pass a budget proviso/enhancement to adequately fund the benefit. In a letter to Senator Judy Warnick (R-Moses Lake) the Health Care Authority projected that in order to add chiropractors to the list of providers to deliver the benefit, it will cost an additional $3.5 million to the state budget. Interestingly, they already claim to provide this benefit but know they won’t actually have to because they won’t let chiropractors provide the service. This gets so old – we know we save the system much greater expense but they always argue add-on cost. We will continue to work on this issue through the session in order to fund a benefit for the underserved and most vulnerable in our state, because we know that we can change clinical outcomes and save costs when chiropractic care is offered.

Fair Pay Protection of Chiropractic Manipulation Codes (CMT)

In our fair-payment legislation several years ago, we protected the evaluation and management, physical medicine and rehabilitation codes. We were not successful protecting the CMT codes because legislators believed that the codes used by osteopaths and naturopaths described significantly different services. In fact, they are the same! We believe that in our discussions with legislators over the physical therapy spinal manipulation bill, we were able convince many legislators that the osteopathic codes describe the same services, and that spinal manipulation however described is spinal manipulation. Whatever you call it, if it has a grade V thrust, it is the same as a CMT and payment for the service should not be higher to other providers. In fact, we know that at least one insurer is paying a minimum of up to 50 percent more for the same service. This is a “heavy lifting” bill so we will need a great deal of grass roots in order to accomplish our goal. Your efforts will help!

Co-Pay Rates

In 2015 we passed many parts of a bill relating to prior-authorization problems with insurers and the networks they hire to manage patient benefits (not effective until 2017). One section of the bill we did not pass regards co-payments that are greater than the fee allowed the provider. In addition, the insurance company is charging the employer a premium for the service. When the patient is paying the entire amount out of pocket, there is no benefit. What’s the extra premium for? These situations are discount plans, not insurance benefits. We will continue to pursue this issue in the 2016 session.

As always, we have a full plate for the upcoming session, and we need your support! If you have contributed recently and/or are a regular contributor to the WSCT, it is appreciated and it makes a difference.

Just click HERE to make either a one-time or recurring donation.

Make a one-time contribution:

$1000, $500, $250, $100

Sign up for monthly credit card withdrawals:

$100, $50, $25 Monthly

P.S. Schedule with your legislators now and attend the 2016 Annual Legislative Day on Thursday, February 4, 2016 in Olympia. We look forward to seeing you all and as usual, you may contact the WSCA office at 206-878-6055 for assistance with your state legislative districts and legislators.

— Dr. Dave Butters, WSCT President