Referral Requirements
The WSCA has been fielding a great number of calls about plans that have referral requirements for chiropractic care. The statute that disallows this practice applies to state regulated health insurance plans only. In other words, those plans that are self-funded and self-insured (large employer groups who can underwrite their benefit risk), or are a Taft Hartley plan (union negotiated), can implement differing rules from state law. The self-funded and self-insured plans are created by the employer, with input from their human resources departments, and can establish their own rules for access and benefit limits. These plans have rules that are out of the normal range of rules from state regulated plans and can be terribly confusing to both providers, and patients. Here are some of the odd rules:
Each of these examples demonstrates methods of cost containment by the employer and is usually
through their human resources departments, that they do not like these rules. If you encounter patients who have a plan that limits access or has permission based benefits, suggest they go to their employer human resources and complain. This is the direct process for them to have their
benefits of chiropractic, not only through productivity of their employees, but in cost savings as well as limited drug needs.
As always, keep the WSCA informed by sharing what you learn about your patients’ health plans and specific benefits.
Plexus Oct/Nov 2017 13
Make sure that you ask the question, every time, if the plan requires prior- authorization or you could be left liable for the cost of the service(s) after delivering care.
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