UPDATE: Communication Between Blue Shield and Participating DCs
October 25, 2018
From the Managed Care & Insurance Committee
CalChiro recently became aware of a communication between Blue Shield of California and the plan’s participating doctors of chiropractic (view letter here) indicating Blue Shield will no longer reimburse doctors of chiropractic for physical therapy services for members whose health benefits are offered through Covered California beginning on January 1, 2019. Representatives from CalChiro immediately initiated contact with Blue Shield to discuss this issue and have learned the following: 1) Many Blue Shield plans do reimburse for services provided by doctors of chiropractic and this policy only applies to Covered CA plans. 2) Blue Shield believes their hands are tied on this issue and that because “chiropractic services” are not specifically named in the Essential Health Benefits (EHB) benchmark plan selected by the state, Blue Shield could be subject to DMHC fines if they fail to maintain strict adherence to the Affordable Care Act requirements. 3) A representative from Blue Shield indicated that the plan would support efforts by CalChiro to resolve this issue with Covered CA/DMHC as they understand and appreciate the value proposition doctors of chiropractic provide.
CalChiro will continue to engage with Blue Shield on this topic and has begun outreach with Covered California representatives to present evidence and interpretation of how services rendered by doctors of chiropractic should be included in the Essential Benefits requirements moving forward. This will be a long journey, but with support of CalChiro members, through continued submission to the CalChiro office documentation that shows Blue Shield (as well as other health plans that serve Covered California enrollees), our task will be accelerated. Clearly doctors of chiropractic delivering EHB services consistent with our scope of practice should be reimbursed for those services as prescribed by the provider nondiscrimination provisions contained within the Affordable Care Act. We will continue fighting to make certain our profession appropriately included in these important discussions.
Please send your documentation to firstname.lastname@example.org or fax to 916-648-2738.