Chiropractor Robert A. Hayden, a spokesman for the American Chiropractic Association, explains how he performs a Medicare patient’s spinal manipulation. He is founder of Iris City Chiropractic Center in Griffin, Ga.
Anthony Fox, VPC
The state’s largest health insurer is fighting back against what it calls a “smear campaign” about its plans to increase oversight of benefits for chiropractic care, physical therapy, acupuncture and occupational therapy.
Horizon Blue Cross Blue Shield of New Jersey filed suit this week in U.S. District Court against the New Jersey Doctor-Patient Alliance, an advocacy group for independent physicians and other medical professionals, including chiropractors.
The suit demands that the group take down its ads and petitions urging opposition to Horizon’s plan, post “corrective advertising” and reimburse Horizon for economic losses caused by the alliance’s “false” and “misleading” statements.
The president of the Doctor-Patient Alliance said the group’s statements were based “in fact,” and welcomed the opportunity to prove its claims in court.
The dispute centers on Horizon’s contract with American Specialty Health, an Indiana-based company that is to manage a network of physical health service providers for Horizon’s members, review claims, and evaluate whether some services are medically necessary.
Horizon says the partnership is necessary to tame rising health care costs, and that New Jersey residents use twice as many chiropractic services as patients elsewhere.
The state Department of Banking and Insurance has 60 days to approve the contract, which Horizon has said it plans to implement on Jan. 1. The application has been filed with the state, which “is currently reviewing it for completeness,” said Trish Graber, a spokeswoman for the department.
American Specialty Health also filed a similar, but separate, lawsuit in federal court against the Doctor-Patient Alliance and the Association of New Jersey Chiropractors, which has waged a parallel campaign against the Horizon partnership.
“We believe that there have been many false and misleading statements, and we are committed to getting truthful information out to the public,” Lisa Freeman, a spokeswoman for American Specialty, said of the lawsuit. The company is “committed to setting the record straight,” and “to implementing the Horizon program and serving New Jersey residents,” she said.
In response, the head of the chiropractors’ association accused American Specialty of “attempting to stifle the free speech and expression rights of our members and, more importantly, their patients,” by filing the lawsuit.
“In our opinion, [American Specialty Health] has a history of denying care, improperly paying claims, and creating roadblocks to conservative care,” said Amy Porchetta Boright, executive director of the association. “We will not be silenced when trying to educate the public. … New Jersey residents should be allowed to voice their opinion to legislators regarding concerns they have with their benefits,”
Horizon’s plan, announced in August, has generated a flood of opposition from the providers affected. They and their patients had sent more than 170,000 emails to legislators and insurance regulators by last week, according to the chiropractors’ association.
The Doctor-Patient Alliance’s website urges members to “Take Action Now! The Horizon/ASH Partnership Threatens Your Benefits!” Patients and providers should tell lawmakers and insurance officials to “Say NO to the Horizon/ASH contract,” the website says.
According to the Doctor-Patient Alliance, “there could be a steep increase in improper claim denials.” This is “bad news” for Horizon patients and those who treat them, it says, as “cutting benefits appears to be the business model” of American Specialty Care.
Rubbish, said Horizon’s attorneys.
“These statements are false, reckless, offensive, malicious and outrageous,” according to the lawsuit. The Doctor-Patient Alliance “disseminated these statements to cause alarm and create confusion.”
Dr. Peter DeNoble, an orthopedic surgeon in Wayne who is president of the alliance, said “everything we put out there is based on fact.
“When we go to court,” he said. “we will be able to present a trove of information” about the experience of the group’s members with American Specialty Health through another insurer, Cigna, with which American Specialty has a contract. .
The alliance has about 350 members, DeNoble said. They are physicians and other providers who are “on the ground, seeing patients at the working end of [American Specialty Health’s] denials.”
American Specialty Health has said it will review some claims after the patient has visited the provider five times, to see if they are medically necessary. This will increase the paperwork burden on providers and could delay or interfere with treatment, critics of the plan said.
If Horizon members cannot make full use of the 30 visits most plans cover, it may also cause financial harm to independent chiropractors and physical therapists, DeNoble said. That will “hurt the small business, the mom-and-pop shop, that provides the higher-quality, more personal care,” he said.
Horizon’s partnership with American Specialty Health will affect plans that cover about 2.7 million people, although only about 400,000 make use of physical health services, a Horizon spokesman said.
The plans affected include state and federal employee benefits programs, large and small private employers, self-funded employer groups that are administered by Horizon, Affordable Care Act plans and individual policies. The program will not affect people with Medicare supplemental (“medigap”) policies or people on Medicaid.
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