It’s a new year and many chiropractors are evaluating what will enhance their respective practices, particularly as it relates to their bottom line. One of the most common questions I get is: “Do I need to be credentialed to bill insurance, and what are the best plans to join?” It’s a loaded question – but one every DC ponders. Whether you're already in-network or pondering whether to join, here's what you need to know.
Ohio, Kentucky Associations Aided Indiana in Insurance Campaign
In "Indiana Association Campaign Reverses Insurance Co. Policy" (DC, Ap. 19), we reported the efforts of the Indiana State Chiropractic Association (ISCA) to get Anthem Blue Cross/Blue Shield to reverse its policy that denied reimbursement for treatments using electric muscle stimulation, TENS and PENS.
We have since learned that the Ohio State Chiropractic Association (OSCA) and the Kentucky Chiropractic Association (KCA) were also involved in resolving this matter. We apologize to the leaders and members of those state associations for not including their contributions.
OSCA assembled an ad hoc committee comprised of past president Robert Poteete,DC, and Ronald Fudala,DC,DACAN. Drs. Poteete and Fudala were instrumental in painstakingly analyzing Anthem's medical policies, reviewing relevant research, and crafting and presenting arguments to the Anthem medical policy committee. The DCs were able to document the effectiveness of the therapies, while exposing the poor science used by Anthem in making its policies.
Through meetings with Anthem, state legislative leaders and their respective state departments of insurance, OSCA, ISCA, and the KCA were successful in an unusual tri-state effort to curb the Anthem policy. Members from each association also contributed by contacting their legislators and state insurance officials.
A significant contribution to this effort was provided by Neil Spielholz,PhD,PT, who serves as a research professor for the University of Miami School of Medicine, department of orthopaedics and rehabilitation in Coral Gables, Florida. OSCA enlisted the help of Dr. Spielholz, who authored an extensive memorandum detecting the flaws in the research Anthem relied upon to support their position that EMS and other therapies were investigational.
OSCA also received and provided to Anthem a position paper from the National College of Chiropractic (department of chiropractic practice), relative to and in support of the use of electric muscle stimulation for various therapeutic purposes.
Drs. Bartley and Payne from Indiana and Drs. Byers and Morris from Kentucky also lent their support in the fight.
Congratulations to the leadership and membership of the three state associations for taking the time and initiative to educate Anthem about the knowledge and skill of chiropractors.