Therapist blasts Anthem's new policies
While officials from Washington, D.C., to Sacramento blast Anthem Blue Cross for proposing rate hikes as high as 39 percent and cutting reimbursement for services, a South Coast businessman has joined the fray against the Thousand Oaks-based health-insurance giant.
Anthem Blue Cross of California planned to reduce its reimbursement to physical therapy, speech therapy and occupational therapy providers between 25 and 200 percent per visit beginning this month. However, Anthem reportedly has pushed the effective date back to March 1 for some providers.
“Should this new policy stay in effect, the difference in reimbursement rates becomes the patient’s financial responsibility, which has already started to cause higher out-of-pocket expenses for the patients,” said Dr. Maury Hayashida, physical therapist and owner of Hayashida & Associates Physical Therapy, Inc., which has had offices for 10 years in Santa Barbara, Montecito and Goleta. The announcement is “particularly disconcerting as it is already one of the most expensive PPOs (preferred provider organizations) in the market,” Hayashida said.
“As a result of the decision, the accessibility of necessary rehabilitation for millions of children and adults has been severely limited,” Hayashida said. “Therefore, health-care clinics, organizations and Anthem beneficiaries have posed this question to Anthem Blue Cross: ‘Has the new policy corrupted the integrity of quality health care?’”
Meanwhile, the state’s insurance regulator said yesterday his office found some 700 violations by Anthem, California’s largest for-profit health insurance company.
Insurance Commissioner Steve Poizner said alleged violations that occurred between 2006 and 2009 include late claim payments, giving misleading information to consumers and failing to cooperate with regulators. The company faces up to $10,000 in fines for each violation.
“We take the issues raised by Commissioner Poizner very seriously,” said Kristin Binns, vice president of public relations for Wellpoint Inc., Anthem’s parent company. “We look forward to receiving the specifics from the investigation and to working with Commissioner Poizner and his staff to resolve these issues to his satisfaction and in the best interest of our members.”
The physical therapy issue brought members of the rehabilitative disciplines to Sacramento for a meeting with the California Department of Managed Health Care on Jan. 26. “Should the state determine that Anthem Blue Cross has limited the access to patient care with this new course of action, they will be required to withdraw the policy in order to escape a fine,” Hayashida said.
He feels the therapy reimbursement reduction is another example of why the nation's health insurance system is in need of reform. “Unfortunately, I think this is a trend that has been going on and will continue. People being able to rely on their health-insurance policy to provide the quality and specialization of care they desire and deserve is a thing of the past.”
“The rate increases being reported in the media relate only to the individual insurance market, which represents less than 10 percent (or about 800,000) of our California members,” Anthem spokeswoman Peggy Hinz said in an e-mail response, referring to those clients not covered by group health plans provided through their employer. “Anthem operated at a loss in its individual business in California during 2009.”
"An independent actuarial firm examined our rates and concluded they are both sound and necessary, reflecting the expected medical costs associated with membership in these plans. They meet or exceed the medical loss ratio required by California law.”
Hinz said Anthem’s profit margin in California is “in line with, or below, many of its competitors, including our two large not-for-profit competitors.”
However, Hayashida said, “Although this seeks to defend the decisions made by Anthem Blue Cross, it does not explain why the rehabilitative medicines have been targeted. In addition, the rate reduction is coming at a time when Wellpoint Inc. has just recorded an 800 percent increase in profit in the fourth quarter of 2009.
"While most companies are forced to reduce their employees’ health benefits due to the struggling economy, Wellpoint Inc. enjoys record-breaking profit gains.”
With mounting opposition to the new reimbursement rate and the refusal by local physical therapy clinics such as Hayashida’s to sign their new contract, Anthem has delayed the policy enactment date. In a Nov. 2 press release, the company said it initially planned to make the changes effective for all therapy clinics Feb. 1.
“This pattern of declining reimbursements by insurance companies to health-care providers raises a fundamental question: What is quality physical therapy and how much is it worth?’ Hayashida asked. “Since insurance companies have the control regarding premiums to the public and fee schedules to providers, it will be up to the public to decide its worth since more and more of the costs will have to come directly out of their pockets if Anthem Blue Cross is allowed to cut reimbursements to this level.”
Hayashida said ultimately it is up to the state Department of Managed Healthcare and Anthem Blue Cross to decide if the reduction in reimbursement is risking access to therapy services.
Comment on this article
Antham : 2/23/2010
If you pay someone to steal from you, why are you surprised when they do it? We've known for a long time now that For-Profit-Health-Insurance is a criminal institution that has been permitted because it has been disguised as a legitimate business. But no other business would be allowed to have such conflicts of interest built into their structure. If a people pay an insurance company to cover their health needs then they should get what they payed for. But shareholders want their profit. How is it that patient needs do NOT superceed invester profits?
Support HR 676. It is the only rational choice.
Nivloc
Antham/Anthem : 2/23/2010
Can't disagree with you (Nivloc), but what you have to say would carry so much more weight without egregious misspellings:
Antham =/ Anthem
superceed =/ supersede
invester =/ investor.
sb in sb
speling : 2/23/2010
Don't forget
payed =/ paid
detailer
: 2/23/2010
The system is broken and it doesn't help that Americans think that they should not have to pay to see a doctor. I don't like our insurance companies anymore than the next person but I sure LOVE them compared to the government. DMV ring a bell? How about our post office? As soon as you get up to a window they put the next window sign up because it is time for their coffee breaks. Imagine trying to get through to them for your health care issues. GOOD LUCK to us all.
Post office simile : 2/23/2010
To another person who mistakes HR 676 for socialized medicine. Socialized medicine is a situation where the government BOTH owns the heathcare facilities & hires the docs and other employees. No competition, low incentive for good work, at least that's the arguement.
But HR 676, written by John Conyers and others, preserves the indepenant ownership of those facilities while the government pays the bills. In this scenerio a doctors good reputation and record of success brings him or her more business. If the doc is no good he looses business, if the standards are not followed she looses funding.
What you don't have under HR 676 is a shareholder taking money away from healthcare.
And know mater Howe bad mie speling thees facts wil stnad the tset of time. But thanx for the assist anywat. ;-)
Nivloc
PS : 2/23/2010
And in case you missed it, neither the DMV or the Post Office are privately owned.
Nivloc
: 2/23/2010
Try going to the doctor in England where the government pays the bill. I have. It's a mess. It took me 3 months to get a mammogram because I had a painful cyst. By the time 3 months came around, my cyst had dissolved but the pain I was in for 3 months was unbearable. I'm glad it wasn't anything serious but why can't I get a mammogram if the doctor says I need one. The health care work force of England employs 1 million people. The tax payer pays their payroll. They are the 3rd largest employers behind The Red Army of China and the Indian Rail Road Corporation. Just to pay the bill? Get real. If only it were this simple.
Get real : 2/23/2010
As I recall, England does have Socializedmedicine. The hospitals are not privately owned. Perhaps, if they were, you would have gotten that mamogram when you wanted, or at least some antibiotics to treat your mastitis.
Nivloc
China, Red army, socialism threat : 2/23/2010
Are there still people out there who are afraid that the comies are coming? Well, we should do away with our fire departments, our police stations, our libraries, our post office and privatize them all.
Of course, don't expect a cop to come to your aid, or a fire fighter to put your house fire out unless you've paid your premium. Oh oh, they just raised your rates... Let it burn!
What about privately owned libraries? Sounds nice, except that this privately owned library doesn't seen to have anything on Ronald Reagan. Must be a mistake, and the next library only carries gay porn. Where is that rightwing conspiracy library I've heard about?
Nivloc
Curious Offer : 2/23/2010
I very recently received a mailing from Anthem which claims the following "Good News! There's an affordable health coverage plan JUST FOR YOU from Anthem Blue Cross. HOW RIDICULOUS! Do they think I (or others) would trust them on this? Am seriously considering forwarding the mailing to Poizner and suggest you all write him as well whether or not you have received such mailings.
Susan
Anthem Blue Cross : 2/23/2010
I thought the effective date was changed to May 1st, not March 1st. This is just a commentary on why reform is needed. Maybe the increase is appropriate, but I can't see how this can be. They should be embarrassed, worse yet, they aren't. Is this a ploy to get everyone's attention?
preston.eileen7@gmail.com
Anthem and the Government : 2/23/2010
Why is anyone surprised that the Anthem Blue Cross Insurance Group is permitted to do the same thing as any other insurance group has done? Home insurance groups refused to pay the home owners what was a just request to pay them in order to restore their homes after a hurricane destroyed them. The Government allows this practice all the time. Be it car,home or health insurance. We all know where the heart of Government and Big Business lies. It is in the of prestige and money. GOD of money is not dead!
$$$$$$$$$$$$$$$$$$$$$$$$$$$$
: 2/24/2010
We have both privately owned and government run hospitals and insurance providers in England. Unfortunately, the privately owned and run hospitals are much more expensive than the government operated hospitals since they pay more in taxes and payroll. Our private healthcare insurance is on the rise however, due to better service that they provide. Generally speaking healthcare providers are great at what they do, it's just the matter of who can afford it and who can't.
All Health Care Practioners Should Take This Stand : 2/26/2010
As a Santa Barbara Chiropractor, I salute their decision to refuse to sign the new contract. If we all got together and did this there would be no choice but for Anthem to reconsider. We have power if we stand together.
Jamie Phillps, DC
601 E. Arrellaga St.
Santa Barbara, CA 93103
Jamie Phillips, DC
that is why we need single payer : 2/27/2010
to get rid of these greedy for profit corporations who do not want to give us health care but rob our money
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