Message #2174

[Cap'n Preshoot]

From Consumer Health Digest

"Chiropractic class-action suits filed against insurance companies

Two suits have been filed by chiropractors against insurance companies that have tried to recover what they believe were unwarranted payments. One suit (Case No. 3:09-cv-03761), filed in New Jersey Federal Court by five practitioners and three state associations, charges that Aetna made improper repayment demands and that its post-payment audit process violates the federal Employee Retirement Income Security Act of 1974 (ERISA).
http://www.casewatch.org/civil/chiro/aetna/complaint.pdf The action also claims that certain Aetna clinical policy bulletins misclassify chiropractically accepted procedures as experimental and investigational. The other suit (Case No. 1:09-cv-05619), filed in Chicago by 15 practitioners and their state associations, accuses the BlueCross BlueShield Association and a number of its state-based licensees of similar wrongdoing.
http://www.casewatch.org/civil/chiro/bcbs/complaint.pdf

The amounts of money involved in the individual payment disputes vary from a few thousand dollars to several hundred thousand. Both suits seek class-action status for all health care providers who, during the previous six years, were asked to return money based on post-payment determinations that their services were not "covered services" or "medically necessary."