BCBS and Orthonet Information – October 2012

Many of you are aware of the recent announcement from Blue Cross Blue Shield of Illinois regarding their contract with Orthonet to perform Utilization Management across the state of Illinois, to commence sometime in 2013.  If you are not aware, please read the article in the October 2012 BlueReview.

First, we want to make sure that all of our doctors know that we are aware of and are working on this issue.  Prior to the official announcement, during a recent meeting between the ICS and BCBSIL, BCBSIL representatives briefly mentioned the future implementation of a contractual utilization management program; however, the program announced in the BlueReview is quite different than the program that was described during the meeting and further clarification is needed.  Even at this time, BCBSIL representatives are saying they do not have full details to give to providers.

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We are working diligently to get clarification of this new program from BCBSIL:

1. details on implementation,
2. provider pools affected (tiers vs. entire physician population),
3. date of implementation,
4. clarification in light of the PPACA non-discrimination clause,
5. applicability to non-participating providers,
6. a clear definition of “Fully Insured,” and other issues of interest and importance.

Although the announcement may not be helpful for chiropractic or your patients, we believe it is absolutely critical that we obtain these points of clarification in order to understand the full impact of the change and to determine our best course of action.  We appreciate our members’ understanding that we will need a short time to gain this clarification, after which we will formulate an appropriate response within the confines of the law.

Conclusion

The Illinois Chiropractic Society always works diligently on your behalf to the fullest extent that the law will allow.  We would encourage all physicians to be extremely cautious during this time to avoid any accusations that might be viewed by regulators as antitrust violations.  The Illinois Chiropractic Society reminds all doctors that state and federal antitrust laws prohibit agreements among competitors that unreasonably restrain competition.  Charges of antitrust violations are often based upon discussions among competitors regarding prices, price levels or price mechanisms, and also include agreements to participate or not participate in any network agreement.  The ICS does not condone or participate in any such discussions, and we strongly urge our doctors to practice the same restraint.

Thank you for your patience during this brief period of investigation.  As always, we will assert all efforts to gain information and bring it to our members as quickly as possible.