Highmark delays controversial therapist program for third time
By Alex Nixon
Published: Friday, Dec. 28, 2012, 12:01 a.m.
For the third time since August, Highmark Inc. is pushing back the start of a controversial program that would limit the number of times its members can receive treatment from a chiropractor or physical therapist.
Highmark, the state's largest health insurer, said on Thursday that it will continue a “soft implementation” of its Physical Medicine Management Program until April 30, 2013. During that time, Highmark said it will not deny claims for chiropractic or physical therapy treatment.
“Based on regular and ongoing feedback with providers, Highmark wants to allow physical medicine providers (doctors of chiropractic, occupational therapists, osteopathic physicians, physical therapists and facilities) impacted by the program additional time to become accustomed to the guidelines and requirements of the program,” Highmark said in a statement to the Tribune-Review.
The program, which requires chiropractors and physical therapists to get authorization from Highmark to provide more than eight treatments in a year, was originally to take effect Sept. 1, before being pushed in late August to Oct. 1. Then in late September it was extended again until Jan. 1.
“During this soft implementation period, no denials based on medical necessity or appropriateness will be issued for requests with dates of service on or prior to April 30, 2013,” the statement continued. “Highmark believes strongly that this program will ensure more effective care for Highmark members. Highmark wants to make certain the member is getting the right care at the right time and in the right setting.”
The state's chiropractors and physical therapists have criticized the program as poorly conceived and arbitrarily administered.
Officials with the Pennsylvania Chiropractic Association and the Pennsylvania Physical Therapy Association could not be reached for comment on Thursday.
The insurer's policy would affect about 2,750 chiropractors, 3,450 physical therapists and 800 occupational therapists. Highmark has about 2 million members in Western Pennsylvania. It has not disclosed how many members would be affected by the program.
Highmark is contracting with Healthways Inc., a Nashville-based company, to review treatment plans.
Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or email@example.com.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- That’s a Jeep Cherokee? No retro in 2014 model
- Mustang celebrates 50th in grand style
- PNC to pay $81M to Freddie Mac to resolve problem mortgages
- Sears to spin off Lands’ End business
- Unemployment rate falls as employers add 203,000 jobs nationwide
- American Eagle Outfitters’ quarterly profit down 68 percent
- Consol cuts office workers after Murray deal
- Market rebounds on strong jobs news
- Mercedes offers luxury for the rest of us
- Wheel alignment key to wear
- Pennsylvania, other states considering bids to host Boeing 777X production