American Specialty Health, which recently agreed to an $11.75 million settlement, along with Cigna, in a chiropractor-initiated class-action suit filed against the two, has been dealt another blow. The New Jersey Department of Banking and Insurance has disapproved a proposed partnership between ASH and Blue Cross Blue Shield of New Jersey, as revealed in an Oct. 16, 2019 letter from N.J. DOBI Office of the Commissioner to Amy Boright, executive director of the Association of New Jersey Chiropractors:
"On Aug. 16, 2019, the Department received a contract for its review regarding a possible partnership between Horizon Blue Cross Blue Shield of New Jersey and ASH for the Horizon BCBSNJ Chiropractic & Physical Medicine Services Program. The department reviewed it and, on Oct. 11, 2019, disapproved the contract. Horizon and ASH may resubmit a new contract for the department's review."
The N.J. DOBI letter was in response to a letter from Ms. Boright / the ANJC urging the department to "closely scrutinize" the proposed partnership between Horizon and ASH based on the recent class-action settlement and the allegations therein. According to the ANJC letter:
"The case brought to light many of the improper practices that [ASH] was implementing while performing ‘utilization management' and denying medically necessary care, amongst other aspects that interfered with patients' access to medically necessary care."
"The very same improper actions detailed in the Class-Action complaint will likely be imposed on the citizens of New Jersey that have Horizon as their carrier should ASH administer Horizon's chiropractic benefits in the same manner it did with Cigna."
Read "A Victory Worth $11.75 Million" in our November issue for details on the Cigna / ASH settlement.
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.
The geriatric curve – the progressive decline in our health, fitness, mental capacity, and overall constitution – graphically appears as a downward sloping line over time. It is a culmination of the effects of sarcopenia, postural deterioration, frailty, and chronic noncommunicable diseases that occur as we age. While aging cannot be reversed, the goal is to reduce the negative slope or “square off” the curve, thus avoiding a steady decline in health. Here are five ways to get your patients started.
Imagine an environment in which DCs are tightly integrated with their local healthcare system; a trusted resource for PCPs, specialists and self-insured employers; are reimbursed in alignment with value created; use modern technology enabling them to fully engage with their patients; are self-governed; and are able to maintain a fulfilling work-life balance. In the final part of this three-part series, we explore three areas for chiropractors to focus on to leave the current foolishness behind and create “the best of times” for DCs and their patients.
