Important Premera Insurance Changes Coming in 2016 which will affect your Chiropractic Health Insurance

Doctor Andy’s Wellness Corner

By: Andy Marrone, D.C.

Clinic Director,

Redmond Ridge Chiropractic

Important Premera Insurance Changes Coming in 2016 which will affect your Chiropractic Health Insurance

            I’m going to break away from the health care advice for a second because some very important information has come my way.  This information involves major changes to a major insurance company.  As an in network provider for said major insurance company (Premera), I received my monthly newsletter about 2 weeks ago.  In the second paragraph was the following statement: In order to provide high quality cost-effective health care, certain services will require preapproval.  This spells doom for your important chiropractic coverage.

In 2009, United Health care, through Optum health, started a pre-approval process for chiropractic care.  This means, when I see a patient who is United, I have to go online fill out a ton of online forms, and United will then get back to me as to how many visits they approve.  United will approve anywhere between 3 and 9 visits.   After that, I have to do another exam, and ask for more, which usually gets denied, or they approve 2-3 more visits.  And the process continues with the number of visits diminishing until they deny additional coverage. IT DOES NOT MATTER IF YOUR INSURNANCE COVERS 100 VISITS PER YEAR, UNITED USES THIS PROCESS TO LIMIT THE NUMBER OF VISITS.

            The American Chiropractic Association sued both United Healthcare and Optum Health, and we actually won the case.  Unfortunately, United & Optum continually appeal the case.  Even though we continually win the appeal, they continue to re-appeal.  As long as the appeal is in process, they are not required to reverse their policy.

Soon after, Healthways instituted a similar policy, affecting Cigna and Group Health providers.  In 2013, Regence got on board (Regence typically allows 6 visits, and Healthways 8).

Now, effective 2016, Premera will be instituting a similar policy.  In my office I have been notifying my patients of the upcoming change, and NONE OF MY PREMERA PRACTICE MEMBERS WERE NOTIFIED OF THIS CHANGE BY PREMERA.   While the details of this change are unclear, including who will be affected and how much it will curtail your ability to receive care, it does mean that your rights are being seriously violated.

The Supreme Court ruled that your benefits are part of your overall employee compensation.  When an insurance company inhibits your ability to use your benefits, they are reducing your compensation.  The Supreme Court ruled this as unconstitutional.

In this time where benefits are being curtailed, can you afford to wait until you get injured to receive care?  Your insurance company will not approve enough visits for a full recovery.  Preventative and maintenance care become all the more important.  While insurance does not cover preventative chiropractic care, it is clear they are really not going to fully cover injury based care either.

 

  • Call your local representatives to notify them of this injustice
  • Call the insurance commission today to notify them as well
  • Call your employer’s human resources department
    • see what they are doing to combat this illicit behavior.
  • Call your insurance company, and explain their policy is unconstitutional
  • Financially prepare to pay cash for many forms of alternative health care
    • You can still use health savings & flexible spending accounts

 

Make sure you mention the supreme court ruling in with each phone call.