NC Insurance: Are you getting what you pay for?
Describing a company that is supposed to help keep your chiropractic health care costs reasonable, as a cartel seems extreme. After all, we’re not talking about people who are selling weapons on the black market. None the less, HNS (Health Network Solutions) who states that they “partner with payors (your insurance), employers and healthcare professionals (your chiropractor) to provide innovative services and solutions to make health care more accessible, more effective and more affordable for everyone” are in fact facing a lawsuit for making it more difficult get the chiropractic care coverage that they paid for.
Even more alarming is that this is not just a problem for people buying insurance, which thanks to Obamacare everyone is legally required to do under threat of fines. All tax paying citizens are paying the price literally when our tax dollars are going to allow chiropractic care to be covered for all state employees but because Health Network Solutions has become a “gatekeeper” in North Carolina to the patients covered by the insurers they are often not getting what we are paying for.
In fact it is such a problem a large number of North Carolina Chiropractors have filed a Class Action Lawsuit against Blue Cross and Blue Shield, Cigna, Medcost and HNS Management Group in an effort to protect not just the chiropractic profession but the patients in North Carolina who are no longer given a real choice of what healthcare they want to utilize..
According to a current lawsuit, “HNS is a cartel that bullies chiropractors and patients with their Utilization Review Process…. The Utilization Review Process had the effect of restraining covered services to patients, damaging (chiropractors and patients) by denying the agreed compensation for covered services, by restricting service (chiropractors) may provide, and by denying access to covered patients unless (chiropractors) comply with the average cost per patient levels arbitrarily established by HNS in consultation with the Insurers.”
So what does that mean?
- If I want to be an in-network chiropractor I am required to bill through a third party (HNS) who has created a monopoly with BCBS, Cigna, Medocst and other insurers who are under contract to allow chiropractors ONLY under HNS to be in-network.
- If I am in-network (billing through HNS), I cannot see patients beyond a certain number of visits based on HNS “average patient visits” which are currently at approximately 6 visits, regardless of medical necessity and the allowed visits available (usually 30) for chiropractic care.
- Meaning if you pay for 30 visits a year HNS will require your provider to only allow you 6 or they will threaten to or will terminate the chiropractor from the network!
- Bonuses are given from HNS to chiropractors who treat patients at or below HNS’s arbitrary “average patient visits”
- Instead of creating better quality care they are encouraging care based on a number of visits and not the medical necessity.
If you ‘re looking for healthcare, do you want to go to the doctor who treats as little as possible to get paid better or the doctor who does everything absolutely necessary to get you healthy? Most people would prefer the later, especially because they are under the impression that since they have 30 visits or more of chiropractic coverage they will be able to get the care needed to get better.
But is that really the case? This is why Corrective Chiropractic has stayed out of network for so long.
Now if you, the patient, simple pay the provider and then send in your bill to your insurance, it has been our experience that those patients get reimbursed according to what their insurance covers. They don’t have to send in their bill through HNS and they are not penalized if they exceed HNS “patient visit average”. Let’s be honest, if you pay for insurance and insurance doesn’t pay you back when they say they will, you’ll stop buying that insurance. Therefore they have a MUCH higher incentive to treat the patient (their customer) much better than the provider.
Despite all of this, because of patient demand, Corrective Chiropractic is still considering getting in-network through HNS. If you want us to fight the good fight, we will. Ultimately, we just want our patients to be aware of the current state of their insurance coverage in most of North Carolina before we make this transition.
There are three options to choose. You can only pick TWO:
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