Legal Affairs: Major Victories in Suits Against the Blues!
The MAC Legal Affairs Committee, under the direction of committee Chair Dr. Tom Klapp, our attorneys, Executive Director Kristine Dowell, and overseen by Executive Committee member Dr. Christopher Dolecki, remains committed to taking aggressive legal action against any and all health plans that unlawfully discriminate against doctors of chiropractic and their patients. This uncompromising position is what led to the ultimate success in our lawsuits against BCBSM and Blue Care Network.
Blue Cross Lawsuits: Settlement!
MAC President Dr. Damian Palmer, Chairman of the Board Dr. Dennis Whitford, Legal Affairs Committee Chair Dr. Tom Klapp, and Executive Director Kristine Dowell, worked tirelessly with our attorney, Greg Nowakowski, to develop Settlement Agreements that are monumental for our doctors and their patients. Settlement negotiations have resulted in provisions relating to the following:
• Expansion of CPT Code Coverage: Applied in a Non-Discriminatory Manner
• Professional Provider Relations Advisory Committee – Audit Procedures
• Reapplication of Disaffiliated Members
• Marketing Materials
• Assistance in the Physician Group Incentive Program (PGIP) (“Reward Pool”)
• Dispute Resolution Process – Forum for Issues Impacting Chiropractors
As Dr. Palmer said in his opening letter, these Settlement Agreements are not the solution to every problem the profession is facing, but they are a great start!
Other Legal Activities
At the MAC 2015 Strategic Planning Session, the Legal Affairs Committee agreed on one major goal: Target all discriminatory reimbursement and coverage schemes. Now that the lawsuits with the Blues are behind us, we can more effectively work with the Government Relations Committee to end excessive co-pays and ensure that insurance companies pay for all services legally delivered under our new scope of practice (see more in Government Relations section below). In addition, we are working with Blue Cross to minimize confusion stemming from the settlement implementation process and maximize opportunities for chiropractors to receive funds from their Physician Group Incentive Program, also known as the “Reward Pool.”
Obamacare – Ensuring Chiropractic Inclusion
Our Legal Affairs and Government Relations teams have been closely following national efforts by organized medicine to dismantle Section 2706(a) of the Patient Protection and Affordable Care Act (commonly known as Obamacare). This critical provision prohibits discrimination against chiropractors and our patients. Statewide, we have monitored all plans offered under the health insurance exchange to ensure their proper inclusion of chiropractic care. As new plans are offered, know that the MAC is vigilantly monitoring them for chiropractic inclusion!