Horizon Blue Cross Blue Shield NJ sent out letters in the past week to the thousands of licensed acupuncturists, chiropractors and occupational, physical and speech therapists to alert them to the company’s proposed partnership with American Specialty Health Network (ASHN), a national utilization review company. The move immediately raised fear from therapists and chiropractors that the insurer intends to limit how many times patients can see them.
They wasted no time firing off letters to the state Department of Banking and Insurance (NJDBI) to ask regulators to block the arrangement. And they started alerting their patients and state lawmakers about how the company’s partnership with an insurance carrier serving 3.7 million people in the state will discourage treatment and undermine their livelihoods.
Patients will see no difference for the first five treatment visits in 2020. But on the sixth visit, the company may conduct “a medical necessity determination review” and if necessary, ask the medical provider for more information, according to the letter Horizon sent last week.
Horizon spokesman Tom Vincz said said the company’s work with Cigna provides a good example of how ASH operates. Last year, the company reviewed claims and required more information from 1,187 patients out of 12,000 receiving care, according to information providers by Horizon and ASH.
“More than 90 percent of patients received care without providers needing to do anything other than treat their patients,” a statement from the two companies said. But Vincz said he did not have statistics on how many resulted in denied claims.
But this past spring, ASHN and Cigna insurance paid a $11.75 million settlement this spring to resolve a multi-state, class-action lawsuit by chiropractors — including two from New Jersey — whose patients were denied claims. ASHN and Cigna admitted no wrongdoing, according to the Illinois Chiropractic Society, which announced the settlement.
Amy Boright Porchetta, executive director for the Association of New Jersey Chiropractors, said she hopes NJDBI commissioner Marlene Caride will consider this litigation when it comes time to decide whether to approve the arrangement.
The commissioner should also consider what deterring the use of physical medicine will mean to the state’s goal of reducing the over-reliance on addictive painkillers, Porchetta added. “We are in the midst of opioid epidemic — we should be looking to provide greater access to non-pharmaceutical pain management.”
Chiropractors and physical medicine specialists must sign an agreement to join the company’s network by no later than Nov. 1 or lose its provider agreement with Horizon. “I have a lot of anxious therapists — their livelihoods are at stake,” said Brian Mason, president of the American Physical Therapy Association of New Jersey, which represents 10,000 professionals. “The best case scenario is this just creates another administrative burden which will be overwhelming,” he adds.
Michael Goione, a chiropractor with a 30-year practice in Red Bank, says he understands there are some “over-utilizers” in the field of physical medicine, but Horizon should focus its energy on policing them. “This is not about managing care,” he says. “It’s about limiting it.”