September 2007

Black and blues

by Dr. Jeffrey Shay

Last week, I attended a Blue Shield program in Bettendorf.

It was considered to be voluntary (but only about as voluntary as the draft notice I received when the war we wanted to get out of was Vietnam). Not everyone was required to attend. Those not so required fell into three categories:

1. Chiropractors who were not Blue Shield participating providers

2.Chiropractors who don't care if they ever get paid again

3.Chiropractors who, in Blue Shield's opinion, do not register a pulse

Actually, Blue Shield goes by several corporate names in different states. In my state of Iowa, it is known as Wellmark. In other states, it may be called Anthem, Empire or Beelzebub.

The program itself was a teleconference held on a Monday afternoon. I could choose any day I wanted, as long as it was on a Monday. Henry Ford once said that his customers could have any color Ford they wanted, so long as it was black. By the way, guess which day of the week is the busiest in most chiropractic offices.

Anyway, the purpose of the program was to inform us of the details of Wellmark's new physical medicine program. We are no longer considered to be chiropractors, we are now physical medicine "providers," and as such we were to be informed of the new requirements and "opportunities" being offered to us under the new program. They called it a program, in the old Soviet Union it was called a "Five Year Plan." I can't remember if the kulaks were also classified as providers.

The teleconference featured a number of remote sites in Iowa and South Dakota, connected with a central location in the state capital. The insurance company had speakers in its headquarters in beautiful downtown Des Moines, which via this hook‑up could connect to the outlying sites operated by one of the Wellmark employees.

We were told that the teleconference would be set up to efficiently give us information on the new program, as well as allow chiropractors to ask questions and have other input.

In reality, the system didn't function well at all. The show started with a company representative telling us how lucky we were to be connected to Wellmark headquarters, which wasn't necessary, since we were already grateful to be there. I once heard a similar speech in a movie, given by the Japanese commandant to the new prisoners on the River Kwai.

After the Wellmark rep read through the first few pages of our handouts, the video screen in our room suddenly snapped over to a group of chiropractors in Ottumwa. Then the audio failed. Then Wellmark headquarters magically reappeared, followed by doctors in Ottumwa looking out the window. Back to Des Moines, where the audio blanked out again, followed by Ottumwa doctors who were probably wondering why they kept appearing on‑screen.

Next, the picture went to Aberdeen, South Dakota, and then over to Carroll, Iowa, with no audio. Sometimes the audio was hardly discernible, while other times it was blaring around the room. On two occasions, questions from doctors in Burlington were not answered due to sound problems. Or maybe Des Moines just didn't like the question.

The jerky handling of the video reminded me of the old 8mm films they used to show us in high school. We had to watch films featuring gory highway accidents, on the theory that it would improve our driving. The projector was usually run by the class geek, often wearing white socks, tennis shoes and a bandana. The film would stutter and shake, and eventually the screen would go blank. Then we could go to gym class.

The new Wellmark policy, as it turns out, is draconian. Every chiropractic visit will have to be "pre‑authorized." i.e., the doctor will have to get permission for every visit before he or she can treat the patient. The pre‑authorization will have to be made by Internet or faxed, including physical findings, diagnosis, prognosis, and doctor's shoe size. Then, the chiropractic "coach" in Des Moines will decide how many visits my invisible patient will be allowed. If necessary, we can get advice on the program from a "trainer." I hadn't seen so many coaches and trainers since the Super Bowl.

We were told that many chiropractors had even asked for a program like this one to help manage their paperwork. After the program, I took a break to look into the restroom mirror to see if I really had been born yesterday.

I've been involved in managed care programs before, but never one of this magnitude. This is nothing but a kick in the head to every doctor in Iowa. Wellmark announced that it had worked on this program with the cooperation of the Iowa Chiropractic Society. At a remote location, an ICS representative noted that their input was largely ignored.

That's no surprise. Insurance companies are famous for using a facade of cooperation, then doing whatever it was they were going to do in the first place. It's like the movie where the victims of the firing squad get to dig their own grave. Wellmark didn't really want any advice, it wanted cover.

This new program is the best argument I've seen for creating a national health care program. Under the present system, things are worsening at a rapid rate. One thing doesn't change...the companies are making regular profits. Under a single‑pay system, insurance company profits would be eliminated. So would the coaches, trainers, and maybe even the insurance companies.

Representative Dennis Kucinich is the only presidential candidate presenting this plan. He points out that insurance company profits, advertising, stock options and executive salaries absorb over a third of the $2.2 trillion dollars spent on health care annually. Under a single‑pay system, all of this could be diverted to actual health care.

As long as the present system is in place, the Blue Shield slogan is probably correct. You just can't beat the Blues.

(Dr. Jeffrey Shay, a graduate of Palmer College of Chiropractic and the WCA's 1996 "Chiropractor of the Year," is the World Chiropractic Alliance Director of Insurance Relations. He welcomes comments or questions regarding any insurance‑related subject appearing in this column. Dr. Shay is available to speak to your state or local organization. Contact him at 1501 Mulberry Ave., Muscatine, IA 52761, or the WCA offices, FAX 480‑732‑9313.)