Help End Provider Discrimination

The ICS strongly urges chiropractic physicians in Illinois to participate in a critical information- gathering process to assist in enforcing provider non-discrimination. Please read the information below and provide the information requested.

Since 2013, the Illinois Chiropractic Society has met with regulators, monitored, met with insurers, and informed Illinois doctors about the progress of enforcement of Section 2706 of the Affordable Care Act. As a reminder, this provision intended to prohibit health plans from engaging in provider discrimination and states that a “group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable state law.” Although the law does not require health plans to accept any willing provider and does allow carriers to have “varying reimbursement rates based on quality or performance measures,” many health plans continue to use varying reimbursement rates based on the category of provider, even when those providers are authorized to and bill for the exact CPT code as other provider types. 

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The ICS believes this varying reimbursement violates the intent of Section 2706.  However, in the absence of Department of Health and Human Services (HHS) adopting rules, there has been little enforcement. After years of waiting, HHS has started the rule making process for this provision.

Recently, representatives of the chiropractic profession and other interested healthcare groups met with HHS to lay out general discriminatory policies by insurers while insurers defended their practices. HHS now wants to review specific instances of discrimination in the cases to which it applies.

The American Chiropractic Association (ACA) is gathering concrete examples of provider discrimination that you have experienced.

Here is the article with the action link and an explanation of the applicable forms of discrimination. Please act today!