a community of practitioners

Anthem Blue Cross in California

Good morning everyone,

Here's an update on Blue Cross of California and how they are impacting healthcare. Recently, BC had decided to limit reimbursement for Physical Therapy to $75.00 per visit with a 12 visit per year cap. Many PTs in my area are furious and are considering stopping acceptance of BC patients.

BC has also raised premiums again, some by 39%, citing increasing healthcare costs. What baloney! BC is dishonest. They pay MTs to go to health fairs and do chair massage and yet BC doesn't pay a dime for massage therapy. I have been called several times by a jobber in SF who looks for starving MTs to do chair massage at health fairs-this guy isn't a MT and admits that the pay is terrible.

Also, Anthem BC's CEO is paid $11.2 million per year. How nice.

Replies to This Discussion

Permalink Reply by Vivian Madison Mahoney on February 8, 2010 at 12:23pm

Jody thanks for sharing this information.

It is true that Blue Cross, Cigna, Anthem and some other companies do not pay massage therapists at all but will pay for massage services IF it is provided by a PT, MD or DC. This is purely discrimination in my estimation. This is why I am starting an organization and will be continuing to request all that wish to get on the band wagon to help me fight to send an email to vivmahoney@aol.com and in the subject line, print I'm With You or something similar.

The reason these carriers do not pay massage practitioners directly is because they are the ADMINISTRATORS for SELF INSURED EMPLOYERS. Under ERISA a Federal Act, they do not have to follow even State Laws such as FL and WA. However WA state is the only state that allows LMT's to contract with insurance companies as network providers. It is my understanding that even in WA, ERISA rules over Self Insured Employer Plans..

State Laws do not superscede Federal Laws. FL had the first state law enacted to require LMT's to be reimbursed by an insurance company and they too have not been able to overcome the Federal ERISA Laws.

However, I have spent 3 hours total in phone conferences, power point presentations and emails with the President of a company who teaches all about ERISA to the medical profession including hospitals. He has indicated to me there may be some loopholes around this in the near future. I am staying on top of that as with all insurance and health care issues to prevent massage therapists from further losses and to try to open new doors for our profession.

All of us working together, continuing positively on the path WILL make it happen!!!

I just read last night in one of my subscriptions on health care reform issues, that several insurers are planning on raising rates up to 39%. If we don't get some kind of health care reform passed this year I fear for those who need it most.

Vivian

Permalink Reply by Darcy Neibaur on February 8, 2010 at 5:11pm

Thank you so much for sharing this information Vivian

Permalink Reply by Vivian Madison Mahoney on February 12, 2010 at 11:17pm

Here is the latest on BC and raising premiums and a link to sign a petition:

http://pol.moveon.org/bluecross/?r_by=18913-15164714-a0qJCRx&rc...

Blue Cross has just announced that it's immediately raising premiums charged to hundreds of thousands of individual customers by as much as 39%—even though their parent company's profits soared to a record $4.7 billion last year.
Even worse, the insurer has so far refused to explain why they're increasing their rates, and warned that they might do so again this year without warning.

The Obama administration is demanding answers from Anthem Blue Cross, and Congress has opened an investigation. But Blue Cross is only going to respond if this story becomes a major public-relations problem for them.
So it's time to turn up the heat. Let's join the growing call for an explanation and send a powerful public message that these abuses by Big Insurance are unacceptable.
A compiled petition with your individual comment will be presented to Anthem Blue Cross.

Permalink Reply by Jody C. Hutchinson on February 14, 2010 at 9:34am

Good Morning all,
I just read that in CA there will be a two month delay in raising premiums. While this takes some stress off for a while, it doesn't address how BC can railroad us to pay more for less.

Permalink Reply by Jody C. Hutchinson on February 23, 2010 at 9:49am

Blue Cross in California was just blasted by state regulators. They are looking at fines for BC's awful business practices. This is long overdue. To make matters worse, my wife has just tried to change BC agents and you can't. The contract provides the agent's commission on the premium even after they retire! How can this be fair? I'm so disgusted with this...Where will this end.

Permalink Reply by Katie M. Feamster on January 25, 2012 at 7:37pm

Vivian Madison Mahoney said:
Dear Vivian,

In the past, I have been able to bill Workman's compensation directly, and although, I have a B.S. degree, I am still a Certified Licensed Massage Therapist. I also just sent my application as a Massage Therapist to Blue Shield. In addition, when I was a Massage Therapist working in a Physical Therapy Dept., there was a list of Massage Therapists Providers-Blue Cross/Blue Shield, along with Horizon, i believe.

ktmary8@gmail.com

Jody thanks for sharing this information.

It is true that Blue Cross, Cigna, Anthem and some other companies do not pay massage therapists at all but will pay for massage services IF it is provided by a PT, MD or DC. This is purely discrimination in my estimation. This is why I am starting an organization and will be continuing to request all that wish to get on the band wagon to help me fight to send an email to vivmahoney@aol.com and in the subject line, print I'm With You or something similar.

The reason these carriers do not pay massage practitioners directly is because they are the ADMINISTRATORS for SELF INSURED EMPLOYERS. Under ERISA a Federal Act, they do not have to follow even State Laws such as FL and WA. However WA state is the only state that allows LMT's to contract with insurance companies as network providers. It is my understanding that even in WA, ERISA rules over Self Insured Employer Plans..

State Laws do not superscede Federal Laws. FL had the first state law enacted to require LMT's to be reimbursed by an insurance company and they too have not been able to overcome the Federal ERISA Laws.

However, I have spent 3 hours total in phone conferences, power point presentations and emails with the President of a company who teaches all about ERISA to the medical profession including hospitals. He has indicated to me there may be some loopholes around this in the near future. I am staying on top of that as with all insurance and health care issues to prevent massage therapists from further losses and to try to open new doors for our profession.

All of us working together, continuing positively on the path WILL make it happen!!!

I just read last night in one of my subscriptions on health care reform issues, that several insurers are planning on raising rates up to 39%. If we don't get some kind of health care reform passed this year I fear for those who need it most.

Vivian