ICS Files Department of Insurance Complaint Against UHC/Optum “Per Diem” Reimbursement Model

By Adrienne Hersh, JD, ICS Legal Counsel · September 8, 20152 min read

Tip of ink pen above the word "complaint" — ICS Files Department of Insurance Complaint Against UHC/Optum "Per Diem" Reimbursement Model

Summarize this article with Paxson

Many of you recently were notified by United Health Care/Optum that it intends to change its reimbursement model for chiropractic physician providers. In Optum’s own words, “Effective December 1, 2015, OptumHealthCare Solutions, Inc. (Optum) will implement a new chiropractic ‘per visit’ fee schedule for UnitedHealthcare commercial products managed by the Optum™ network.”

Under the soon to be implemented arrangement, Optum states it will no longer pay chiropractic physicians under a fee-for-service model. Instead, Optum will pay the lesser of the chiropractic physicians’ customary charges, or a $60 per-visit fee, regardless of the number of services rendered or the charges for services on that day.

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About the Author

Adrienne Hersh, JD, ICS Legal Counsel

Adrienne serves as Illinois Chiropractic Society general counsel and provides legal advice and support on a wide range of legal issues affecting chiropractic physicians, including licensing and other health care regulations, scope of practice, insurance and reimbursement, business structuring, labor and employment, contracts, and litigation. Adrienne previously served for 8 years as general counsel to the Illinois Department of Professional Regulation (now the Division of Professional Regulation, Department of Financial and Professional Regulation), where she was chief legal counsel responsible for overseeing all legal issues and advising the 50+ licensing and disciplinary boards, including the Medical Disciplinary Board and the Medical Licensing Board. She is a member of the Illinois State Bar Association Health Care Section, the Illinois Association of Healthcare Attorneys, and the National Association of Chiropractic Attorneys.