Horizon BC/BS caps insurance co-payments for chiropractors
I received word that because of an action taken by the Department of Banking and Insurance (DOBI) in 2010, copayments for chiropractic visits will be capped at $30 for many of our patients.
Unless you have hidden under a rock, office copayments have risen steadily for specialists, and unfortunately, chiropractors are considered to be specialists even though they are closer to therapists in what they do.
For the average patient, there may be a vague memory of that $10 co payment not so long ago. Cost sharing has run amuck with copay’s being as high as $60. For many patients, the solution was to cut back, only to find out that a few years later, more expensive invasive interventions and chronic pain replaced the need for a couple of chiropractic visits. This is not only not cost effective but it discourages the average person from going for the care they require. For some, it is simply treat or eat.
I don’t know about you, but my insurance goes up every year without fail, but they pay for less and less. Add this to the fact that the recession kept many people away from the doctor and many have postponed medically indicated procedures.
Thanks to DOBI, the cost of chiropractic care is indeed coming down for those who have the average blue cross blue sheild plan in NJ.
Read the press release here
To: ANJC Members
From: ANJC Insurance Advisors
Re: New Co-Pay Law
In 2010, DOBI enacted a new Minimum Standards regulation that affects co-pays for certain insurance policies for several types of healthcare providers. Chiropractors are included in this group.
In order to comply with this new regulation, Horizon BCBS will start applying a $30 maximum co-pay for many of their policies as of 9/1/11. Other insurance carriers, but not all, are expected to initiate changes in their co-pays, as well.
Highlights of the new Co-Pay Regulation:
– For Horizon BCBS claims, if the co-pay is greater than $30, it will go down. If the co-pay is $30 or less, it will not change.
– Horizon BCBS will reimburse patients for co-payments paid in excess of $30 for chiropractic care rendered between April 1st and August 31st 2011. Providers however, will receive no additional payment.
– This regulation applies to individual, small employer, midsized standard and large group accounts.
– This affects only “fully insured” policies.
– “Non-fully insured” policies that fall under ERISA or are self-funded are not required to comply with this regulation (such as State Health Benefits Plan).
– DOBI has determined that not every insurance carrier will have to reduce their co-pays. The maximum co-pay may be a dollar amount or it may be a percentage of the value of the service rendered. These details are still being worked out. It will take time to develop an accurate list.