BCBSIL Orthonet Alert
The most effective method of effecting change is through the purchaser. As we have asked throughout 2013, the ICS is asking doctors around Illinois to inform their patients covered by BCBSIL health plans of the looming changes concerning physical medicine under their BCBSIL policies.
In short, we are urging you to inform these patients of the following:
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1) In order for BCBSIL to pay for their care, your office will be required to seek permission in advance after a certain number of visits if BCBSIL has categorized you in Tier 2 or Tier 3.
2) Advise patients they may contact their Human Resources Directors, Union Representatives, or Insurance Agents as soon as possible and request that they not make changes to their chiropractic or physical therapy services if BCBSIL approaches these plan administrators to change the plan.
3) Additionally, patients should contact BCBSIL directly and voice their concerns over the program.
4) If your patient wants to contact a governmental agency about the changes, they may contact the Illinois Department of Insurance or the U.S. Department of Labor to ask for their assistance in protecting their full rights as a patient.
5) As a valued health care provider, we recommend that your patients take action immediately.
Law
If you have concerns about raising this issue with patients, here is an excerpt from Illinois law: “(215 ILCS 134/30) Sec. 30. Prohibitions. (a) No health care plan or its subcontractors may prohibit or discourage health care providers by contract or policy from discussing any health care services and health care providers, utilization review and quality assurance policies, terms and conditions of plans and plan policy with enrollees, prospective enrollees, providers, or the public.”
We have outlined these steps, along with other information for your patients, in a flyer that is available to download.
Challenge
We are challenging our members to discuss and equip at least ten patients with this information. Additionally, we would challenge you to discuss and equip ten other chiropractic physicians with this information.
The ICS is continuing to look at all facets of this program, legal remedies, and recourse, and other immediate remedies for members who have been placed in tiers 2 and 3, including information regarding the appeal process. We have also renewed our requests to the U.S. Department of Health and Human Services and the Illinois Department of Insurance for an advisory opinion regarding whether the BCBSIL/OrthoNet program, as applied to non-facility providers only, will violate the anti-discrimination provision of the Affordable Care Act when it becomes effective on January 1, 2014. We will keep you all informed with regular email updates.
