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Highmark delays controversial therapist program for third time

| 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 anixon@tribweb.com.

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