Important news for anyone in the School Employee Health Benefits Plan (SEHBP).

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Here we go again.   Last year Horizon Blue Cross Blue Shields wanted to use American Specialty Health to manage care which was proven to be a really bad idea.  Thanks to you, it was denied by the DOBI (Department of Banking and Insurance). Those who are in education and are affected by NIA's arrangements with Aetna know first hand that this not only does not save money but makes going to their chiropractor or therapist a constant issue with pre-denials that inappropriately restrict care. The same people who were behind the ASHN idea are likely behind the new less costly plan that reduces the amount paid out of network to 200% of prevailing fees which is an improvement but they should have gone further to be a good steward of your healthcare plan. Medicare figured out how to do out of network payments cost-effectively years ago, yet insurers instead of using a proven effective model instead have eliminated out of network benefits for most of us.   Basically, we all pay for their poor decisions.

What you need to know about Sweeneys deal and the companion bill S-2273 they are voting on today during the current Covid19 crisis. 

In this new plan with S-2273 that received good press a week or so ago, they also are now reducing paid benefits to chiropractors, Acupuncturists and physical therapists both in and out of network to $35 for chiropractors, $60 for acupuncturists and $55 for physical therapists.  This means that visiting these professionals will cost you more with these caps.   I am not sure who is behind these ideas but they certainly seem to have a problem with chiropractors who many teachers and educators trust and rely on to stay pain-free cost-effectively. I would also love to see transparency on this and find out who has been lobbying these bad ideas behind the scenes and who is funding it over the past several years.   They claim this arrangement will save 1 billion a year, but how does another bad idea from the company that developed the Horizon  Omnia plan.    This plan created tiers that led to further mergers and larger healthcare monopolies in NJ while eliminating all out of network benefits. 95% of the chiropractors in the more expensive tier even though they save money through cost-effective care that is holistic and free of expensive drugs or surgeries while the hospitals, the latest being St. Peters in News Brunswick that was tier 2 joined the large Barnabus system for to become tier 1. Omnia made the less expensive providers and hospitals more expensive while many providers joined larger tier 1 practices for protection.  This was definitely making things more expensive for healthcare in NJ as many Omnia contracted patients now know as they have higher deductibles and premiums that continue to escalate yearly.   As a chiropractic patient, you already know how your chiropractor had helped you and your family feel and function better, without the use of drugs or surgeries or unneeded tests. For many patients, chiropractors, physical therapists, and acupuncturists keep them pain-free, improve how they function and help them avoid costly medical solutions that can be harmful when better solutions are available.  Considering the problems surrounding the opioid crisis, will they ever learn?  Chiropractors are now being recognized by the scientific community as much higher value level providers than ever before, although Horizon continues to attempt to undermine these providers due to professional discriminatory practices such as these which are contained in this bill. To make this even more suspicious, they passed an Assembly bill yesterday without any public discussion while the state and country are being shut down by Covid19. You can help by contacting your legislators through this link. Do it now email your Assembly representatives easily to urge them to oppose the companion bill to S-2273.  I am sure most of our representatives have not read this bill and they would be appalled on how it harms some of the most valuable people in the healthcare system behind holistic conservative care of painful conditions.  It, more importantly, harms anyone who has this plan as your costs will rise for you and your family, and you will no doubt have a smaller choice of providers to choose from. Please do this, and do it now.