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July 2005, Vol. 15, Iss. 3
Table of Contents
A Great Opportunity • Age of Confusion •
APMR Accepts CBP® Research • CBP® has 13 Published Clinical Trials • Chronic Back Pain, Your Brain, & Chiropractic •
Creating a Great First Impression • Evidence Based Exams •
Had Enough? • Lateral Head Flexion from Vestibular Dysfunction •
Letters to the Editor • Life's Rise from the Ashes •
PosturePrint™ is now a Validated Posture Analysis •
The Disease of Unrealistic Expectation • Thousands of Heroes •
When You Can't Critique CBP® in the Peer-reviewed Literature
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Had Enough with Chiropractic Managed Care Groups?
By Gary Cuneo, MD
A few years ago, a group of ACA leaders and I met with the medical directors of 20 Blue Cross plans. The meeting was arranged by the chief medical director of national Blue Cross/Blue Shield as a way for us to address the policymakers on what we believed were discriminatory practices by the Blues against our profession. When we finished our presentation, a couple of the medical directors made some frank observations to us, all of them essentially to the same effect: “It’s not the medical directors that are the problem. It is your own kind. Chiropractic managed care companies are coming to us with business proposals that we would be fools not to accept.”
At the time, we were involved in two lawsuits and didn’t have the resources to pursue other initiatives. But today is another day. The complaints we are receiving from members and non-members regarding chiropractic managed care networks have increased substantially and have caused us to take a more aggressive look at the problem. The “bullying” tactics that are being practiced exceed anything that was around a few years ago. Doctors are forced to practice within a narrow utilization treatment formula. If they exceed the formula, even by a fraction, they are dropped from the panel. Once a doctor is taken off a panel, it is nearly impossible for him or her to qualify on a panel from another company. We are hearing that in one state 40 doctors were kicked off a panel during the last few months. Participants were forced to either “get along” — even if it meant giving patients sub-standard care — or “get out” and lose their practice.
The majority of the complaints we have received have come from ACN, ASHP and Landmark. It is time to act, and this is what we plan to do in cooperation with the National Chiropractic Legal Action Fund. ACA has retained the services of the nation’s premier class action law firm, Milberg, Weiss, Bershad & Schulman LLP, to assist us in our ongoing effort to collect and analyze managed care abuse information from the field. Here are 3 items of action:
1. Initiate, in connection with cooperating state associations, contacts and complaints with state insurance departments detailing the offending actions of managed care groups.
2. Identify what we believe to be specific violations of ERISA claims and appeals regulations by offending managed care groups through the direct intervention of the ACA legal department with the U.S. Department of Labor and the related employer purchasers.
3. Accelerate legislative efforts to educate Congress and the Bush Administration of the ongoing problems in managed care and the toll these problems take on the patient community.
We have a couple of other things up our sleeve that we will leave off this report for now.
At http://www.acatoday.com/
media/releases/052305.shtml, you will find a press release that we distributed in May that provides more information regarding this action and the specific type of data we are seeking. You will also find online a “managed care data collection form” at http://www.acatoday.com/pdf/managed_care_collection.pdf. If you have had problems within the scope of this review with these chiropractic groups or know of doctors who have, please fill out the form and fax it to Laurie Douglass, ACA’s Insurance Director.
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