April 2008

Wellmark gets religion

by Dr. Jeffrey Shay

Several years ago, there was an ex-disc jockey who traveled around Davenport headlining a number of high profile events. He spoke at meetings, church gatherings, and even sang the national anthem at sports events. Shortly before his new-found popularity, he announced he had discovered God and had given up illegal drugs and liquor. He immediately came in demand for events all over the area, and was much more popular than people who had never used drugs or alcohol, a virtual icon in the bi-state area.

All of which I found confusing. I had never looked upon having your own meth lab as a status symbol, let alone using it as a path to being a celebrity figure. I just figured that when you stopped doing illegal stuff, the authorities stopped arresting you. Apparently, this doesn't apply either to him or to Blue Shield.

Case in point: Most law-breakers use aliases, and Blue Shield's moniker in Iowa is Wellmark, which in turn produces a monthly newsletter called "BlueInk," made available to physicians, health care providers, and anyone else who lands on their mailing list. They call it a newsletter, but it's more of a cross between a comic book and Mein Kampf.

Their lead article this month is entitled, "Reduction of Medical Record Requests Successful," in which the carrier brags about requesting 56,000 fewer medical records in a recent period, which amounts to a decrease of 60% over the previous period.

The article notes that the majority of requests for "pre-existing condition reviews" were represented by four diagnoses: sinusitis, tonsillitis, otitis media and bronchitis. Wellmark indicates that, once the medical records were received, claims with these diagnoses were always paid.

Wellmark goes on in a self-congratulatory tone, issuing a glowing statement about "improved work flow" and "reduction in staff time," allowing the Blue Shield staff to use their time more productively, which probably means searching shopping sites on the Internet.

There's probably more to this picture than meets the eye. While Wellmark uses the rest of "BlueInk" to extol the virtues of their paperwork program, the hard truth is that the program exists in order to avoid paying for their insureds' treatment, i.e., a paperwork roadblock designed to enhance earnings and perpetuate suffering.

A number of things were left out of the article. How long had this stupidity been going on? Why was it started in the first place, since they eventually paid for all services anyway? Were complaints from the medical profession behind the change in policy? Or did Wellmark's chief author see a shining star in the east while driving on the Des Moines freeway?

I've never viewed the Iowa Medical Society as particularly warm and fuzzy, and it's hard to imagine this process going on for long before some Wellmark executive would wake up with a horse's head in his bead.

Another question: How does this impact the chiropractic profession?

Chiropractic patients are often reviewed for pre-existing conditions, and any hint at ever having a headache, backache, or slap on the back is enough to attach a rider on the insured's policy until the day he or she is eligible for Depends. No figures are published concerning chiropractic patients, and we are left to assume:

A. Improved work flow is no problem when it comes to dealing

with chiropractic patients.

B. The number of claims paid involving chiropractors is somewhat less than 100%.

The day chiropractors are treated equally in this area is the same day that the waters part in the Mississippi just below Lock and Dam 15.

On another note, there was an article appearing in the February 13, issue of USA Today concerning a marked increase in money spent on back and neck complaints. The article itself was taken from the Journal of the American Medical Association, one of the nation's leading publications devoted to increasing medical profits. The conclusion reached after extensive study of back and neck injuries was that Americans aren't getting their money's worth in treatment for spinal problems.

Now, this conclusion is not exactly surprising to chiropractors, but these guys do a good job of acting surprised.

The article found that spending was out of control in several areas, including outpatient procedures, inpatient services, and prescription drugs. There was also some concern about imaging and diagnostic services, spinal injections, and spinal fusions, with emphasis on the number of unnecessary MRIs on Medicare patients with lower back pain.

Chiropractic was not mentioned, of course, but expenditures seem to be on the increase everywhere else, and no one is getting well.

Imagine that.

I can hardly count the number of times I have successfully treated patients with low back pain, who had already had been subjected to extensive MRIs and other imaging tests, only to be told that they didn't have anything wrong.

In a recent article, I wrote about a VA patient who was refused chiropractic care until he had proper medical examination, including x-rays, an MRI, a CT scan, and blood tests, only to be told that there was nothing wrong, and therefore chiropractic wouldn't be necessary. They also refused him other medical treatment for the same reason.

The article complained about all of the unnecessary costs involved in neck and back cases, only to miss the main point.

Medical treatment was not the better way.

(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.)