Managed Care & Insurance Committee Updates

The Managed Care & Insurance Committee (MCIC) will continue its advocacy activities with stakeholders that either manage services provided by doctors of chiropractic, regulate the health plan industry, as well as other public policy decision-makers. Currently, we have request letters to Cigna and Blue Cross on a variety of issues related to coding and denial language of services, and Blue Shield on the delegation to ASH for services providers to select Blue Shield PPO markets. It should be noted that according to Blue Shield, not all PPO plans will be managed by ASH, and therefore, those Blue Shield-contracted providers should retain their contract status. There remain several outstanding issues from 2019 related to ASH policy/procedures, and we will engage with their leadership on these matters, including some provider confusion related to the Blue Shield/ASH delegation issue.

As we have noted previously, the MCIC will continue our meetings with stakeholders regarding Covered CA. Recently, the Governor created the Health California of All Commission. CalChiro will be in attendance at each meeting and offer information relative to the inclusion of the chiropractic profession’s participation in crafting health care policy. Of interest is several of the commission members, legislative appointees, and ex-officio members have a long history with CalChiro, including presentations to CalChiro conferences and meetings as well as assisting in legislative activities.

January is a particularly challenging time of year related to full service health plans and the delegated entities that manage certain benefits. These challenges include, but are not limited to eligibility determination and verification of benefits, including deductibles. As we have stated previously, CalChiro cannot advocate on behalf of each provider. However, certainly if a global issue is identified that adversely effects all CA-based doctors of chiropractic, CalChiro should be notified and we can initiate discussion with the health plan, or its’ delegated entity. If resolution is not available at that level, presentation of documents and in-person meetings with regulatory personnel will be scheduled.