BCBS of WNY Updates Chiropractic Services

August 22, 2012 Updated Aug 22, 2012 at 7:36 AM EDT

By WKBW News
By Business First by Tracey Drury

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August 22, 2012 Updated Aug 22, 2012 at 7:36 AM EDT

WNY (WKBW) - BlueCross BlueShield of WNY is eliminating limits on chiropractic visits for most members beginning Jan. 1.

The change comes as the insurer begins a new system of managing its chiropractic network, ending a contractual relationship previously managed by Palladian Health.

Under the new network, members will see reviews and pre-authorizations eliminated or streamlined depending on member agreements, though co-pays and cost structure for members will remain the same. Participating chiropractors will see a 5 percent increase from the current reimbursement schedule.

They'll also see decreased paperwork and overhead costs, increased peer representation through a new advisory committee and opportunities for a closer relationship with BlueCross BlueShield.

Dr. Raghu Ram, vice president and chief medical officer, said the changes will make the process more efficient for participating chiropractors while giving patients the opportunity to continue therapies as needed. The changes were made after reviewing a care model that hadn't seen updates in many years, he said.

Patients won't have to tally how many of their allotted 20 office visits remain, or have to check of pre-authorization paperwork has been submitted.

The new system also provides for continued care for patients who don't have the ability to learn in-home exercise programs or who don't have family members to help with massage or traction units. These types of patients have traditionally turned to more expensive and involved surgical options instead, Ram said.

"We looked at our utilization patterns and benefit restrictions and that didn't make sense any longer," he said. "Back care has become very complex, and a lot of surgical treatment and other treatments are occurring when more conservative treatments like physical therapy and chiropractic would work."

Hundreds of area chiropractors currently affiliated with BlueCross BlueShield through its subcontracting relationship with Palladian will remain in network, transferring directly into the new in-house network Jan. 1 when the new plan year begins, Ram said.

BlueCross BlueShield will continue to develop the network with help from its medical management and quality improvement teams, as well as on-staff chiropractors.

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