Request for Blue Shield Documentation From CalChiro’s Managed Care & Insurance Committee
October 05, 2018
From the Managed Care & Insurance Committee
CalChiro and Blue Shield representatives have been discussing
Blue Shield call representatives quoting of benefits for services
provided by doctors of chiropractic for those members with
Covered California health care coverage. Blue Shield has reviewed
their training materials and have advised CalChiro that the Blue
Shield call center representatives are quoting the benefit
correctly. As you know, the only service not available for
reimbursement in this program is Chiropractic Manipulative
Therapy. Other services including, but not limited to E/M codes,
diagnostic radiology, and physical therapy (rehabilitative)
services are reimbursable services. However, the Blue Shield plan
documents state “no coverage” under the chiropractic section.
Blue Shield states their call center representatives do expand on
the benefits available IF ASKED (emphasis added). In addition to
the practitioner frustration, we have noted that members with
this plan are denied appropriate access to doctors of
CalChiro requests its members to ensure that you request from the call center, what benefits are available for doctors of chiropractic. The more documentation that shows Blue Shield is not correctly quoting the benefit, the better opportunity CalChiro has to correct this misinformation. Please also ensure that you document the date/time of the call; the representatives name; and the response to your questions on availability of services reimbursed when provided by doctors of chiropractic.
Please forward this information as soon as you have received this information for the CalChiro office to collate and prepare the documentation for the next meeting with Blue Shield representatives on December 1, 2018. Please send your documentation to email@example.com or fax to 916-648-2738.