Broward Chiropractor Dr. Troy Lomasky of Coast Chiropractic in Wilton Manors Notes Aetna, American Speciality May Have Improperly Denied Chiropractic Claims in Connecticut

Note:  Coast Chiropractic of Wilton Manors (Broward County, Near Fort Lauderdale) takes all major insurance, including Aetna.

Aetna agrees to revisit Connecticut chiropractic claims
8/2/11
Reprinted from the Hartford Business Journal

Attorney General George Jepsen announced Tuesday that Hartford health insurer Aetna and American Specialty Health Networks Inc. have agreed to review and reprocess chiropractic benefit claims that may have been denied improperly under Connecticut law.

Aetna was responding to questions raised by Jepsen after several complaints were made by chiropractic providers on behalf of themselves and their patients.

The complaints were that Aetna's claims administration agreement with San Dieog-based American Specialty Health Network, which took effect July 1, did not include all the chiropractic services covered under state law.

Connecticut law requires health insurance plans to cover chiropractic care "to the same extent" coverage is provided for services rendered by a physician, Jepsen said.

"Aetna's prompt and fair response to this issue means providers will be paid for covered services and Aetna's enrollees will continue to receive the care to which they are entitled," Jepsen said. "Everyone benefits from this cooperation."

Chiropractors licensed in Connecticut are permitted to provide a wide range of services, including the use of X-ray and other diagnostic technology, the administration of foods and vitamins and preventative care. If health insurance plans cover those services when provided by physicians, they also must be covered when provided by chiropractors in Connecticut.

Jepsen said Aetna told his office that the claim system will be updated to include the procedure codes for qualifying services a chiropractor can provide in Connecticut. In addition, ASHN will review eligible claims submitted since July 1 and reprocess those denied incorrectly.



Aetna Apparently Dropped Chiropractic Coverage In July Against State Law, Attorney General Says Insurer Cites Inadvertent Coding Problem, Says It's Reprocessing Claims
August 2, 2011|By MATTHEW STURDEVANT, msturdevant@courant.com, The Hartford Courant

Aetna and American Specialty Health Network apparently dropped coverage for chiropractic services in July, but the insurer agreed to pay bills after chiropractors complained to the attorney general.

Aetna said the issue was an inadvertent coding problem and not a dispute over coverage of chiropractic care.

"We determined that a new national agreement with a chiropractic benefits vendor did not specify all of the procedure codes that chiropractors in Connecticut can perform within the scope of their license," said Aetna spokeswoman Cynthia Michener. "We are currently reviewing claims submitted within the past month to see if any were denied improperly. If so, we will reprocess those claims."

Connecticut law mandates that health insurers provide coverage for chiropractic care "to the same extent" coverage is provided for services rendered by a physician. State-licensed chiropractors can offer services a patient might also get from a physician, such as use of an X-ray and other diagnostic machine to determine medical problems. If those services are covered when provided by medical doctors, they must also be covered when provided by chiropractors in Connecticut.

Attorney General George Jepsen asked about Aetna's claims administration agreement with American Specialty Health Network, which apparently dropped coverage for chiropractic services starting July 1, against state law. The insurer has agreed to review and reprocess the claims that were improperly denied.

"Aetna's prompt and fair response to this issue means providers will be paid for covered services and Aetna's enrollees will continue to receive the care to which they are entitled," Jepsen said. "Everyone benefits from this cooperation."

Estimates were not available to detail how many patients and providers were affected by the dropped coverage or how much was unpaid in claims. Since July 1, American Specialty Health Network provided claims administration and other services for chiropractic benefits available through Aetna health plans, except for Aetna's Traditional Choice plan in Connecticut, according to Jepsen's office.




Broward County Chiropractor Dr. Troy Lomasky heads Coast Chiropractic of Wilton Manors, Florida. A graduate of the famed New York Chiropractic College, he specializes in quickly treating pain from a variety of conditions. Services include: Consultation, X-ray, spinal adjustments & massage therapy, physiotherapy, spinal decompression for disc problems; spinal and muscular rehabilitation. New patients & same-day appointments available. (954) 463-3036 or www.chiropractorwiltonmanors.com. On-call for emergencies 24 hours. Serving Broward, Miami-Dade and Palm Beach Counties.