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Highmark Will Require Prior Authorization for Chiropractic

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by: DrTirpak posted: June 21, 2012

Highmark Reduces Chiropractic Services

Health insurer Highmark Inc. will require prior authorization for chiropractor services starting September 1st in Pennsylvania and West Virginia. Pre-authorization will be required only after the eighth visit for a particular types of services in a calendar year. The policy applies to all Highmark members insured through employer-based group, as well as individual members and Medicare Advantage members.

Chiropractors know from other insurers that this is just an arbitrary cutoff, created to limit costs and create more hoops for DC’s to jump through to get reimbursed. The real losers are patients that pay for health insurance only to have their coverage limited, not based on their needs but insurance companies’ cost cutting measures.

The company set the new threshold for therapy and chiropractic visits at eight because Highmark's data show that "nearly two-thirds of members have their needs met and resolved within eight visits," according to a June 19th press release from the company.

They also claimed “data for some practices during the past two years shows chiropractic care is the second highest paid service for members, second only to cardiac care. The company spent about $200 million in 2010 on chiropractic, occupational therapy and physical therapy payment -- $100 million for chiropractic-related services, and almost $100 million more in occupational and physical therapy reimbursement. “

The outgoing president of the Pennsylvania Chiropractic Association, John Carrin DC stated."They're going to be eliminating care for patients who may need it, [based] on computer algorithms,"

Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.9 million members in Pennsylvania and West Virginia.

Filed Under Tags:  PA  ·  WV

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