Horizon Blue Cross Blue Shield must pay for all chiropractic services

For many years, Horizon Blue Cross Blue Shield has not paid for chiropractic evaluations on their patients and the other services practically all insurance carriers provide. A few years ago, they also reduced chiropractic reimbursements by over 30 percent as well making chiropractors suffer financially. Many, like myself would basically eat the cost of evaluations and the time we spent because of our ethos (chiropractors are all about the patients they serve). A couple of years ago, we had no choice but to charge our patients for their examinations since their policies, combined with other carriers may have made being a practicing chiropractor financially impossible.

On October 7th, 2009, an administrative action we had taken a number of years ago had finally found by the Department of Banking and Insurance ( DOBI) that they had indeed abused their stature and that they must now cover all services performed by chiropractors.

On 1/15/10, all chiropractors will receive the following letter

Horizon Letter:

January 15, 2010

Dear Chiropractor:

Pursuant to the New Jersey Department of Banking and Insurance (DOBI) Decision and

Order pertaining to Order Number A09-113, Horizon Blue Cross Blue Shield of New Jersey

is revising our policy regarding the consideration of Evaluation and Management (E&M)

services and physical therapy modalities for reimbursement separate from the reimbursement

of Chiropractic Manipulative Therapy (CMT) codes.

Horizon BCBSNJ is in the process of implementing Order Number A09-113, which requires

that we evaluate whether E&M and/or physical therapy modality services billed by you are

separately compensable from the CMT and other services billed by you.

Horizon BCBSNJ will engage the services of an external vendor to help us implement this

Order. We will advise you of further details regarding this vendor in the next 30 days.

Our goal is to implement this Order with the least amount of administrative burden and/or

inconvenience to your office and to our members.

Please be advised that any claims that have been processed for dates of service on or after

October 7, 2009 that are not in compliance with this Order, as well as any appeals that have

been received by Horizon BCBSNJ relating to dates of service on or after October 7, 2009,

will be evaluated for consideration within the next 90 days. Any additional reimbursement

amounts will be paid with interest, in accordance with New Jersey Law, based upon the

receipt date of the original claim.

The evaluation of E&M services and physical therapy modalities may require the submission

of portions of your patients’ medical records to support the appropriateness of the services

being billed.

Further communications outlining the details will be forthcoming.

Sincerely,

James F. Albano - Vice President

Healthcare Services

Of course, there was no apology since they clearly knew what they did over the years was wrong. In the end, justice was served for the chiropractic profession and the patients they treat. Perhaps now, I can afford to replace my worn carpeting and touch up the trim in my office.

Dr. C