District Meeting Feb 8, 2012 7p
Please join us for our upcoming District Meeting on February 8th at 7p. The district meeting will be held at Presidente Restaurant located at 11451 Sepulveda Blvd in Mission Hills (Click here for a map and directions). A meal will be served at this meeting and the cost is $20 for members and $30 for non-members. Please RSVP no later than February 3rd by either replying to the email newsletter or responding via fax using this form.
Our meeting will feature a presentation by Dr. Brad Glowaki entitled "Increasing Your Voice In The Community." Dr. Glowaki will show you how to attract new patients and pre-qualify them in the TGE process.
Dr. Brad Glowaki is recognized as a whiplash specialist in both detecting and correcting any auto related injuries. He works with professional athletes sports injuries as well as designing lifestyle enhancement programs that go beyond initial symptoms and help improve overall wellness goals.
As the 2004 Seal Beach Chamber of Commerce President Dr.Brad Glowaki has established himself as a reputable fixture in the community. The recognition, however, goes beyond local status as he has been voted to National Register's "Who's Who?" list of top Chiropractors Nationwide for 2005.
The list of awards and accolades is impressive for service and chiropractic care at this office. Yet some patients say that the greatest aspect of this office with a huge reputation for excellence, is the small approach and personal attention each patient receives from this "single-chiropractor" practice using a very specific and detailed approach in providing chiropractic care.
Many Patients have avoided surgeries under DC Brad Glowaki's care and have been shown techniques to ensure a healthy lifestyle beyond their initial complaint.
Our meeting will feature a presentation by Dr. Brad Glowaki entitled "Increasing Your Voice In The Community." Dr. Glowaki will show you how to attract new patients and pre-qualify them in the TGE process.
The list of awards and accolades is impressive for service and chiropractic care at this office. Yet some patients say that the greatest aspect of this office with a huge reputation for excellence, is the small approach and personal attention each patient receives from this "single-chiropractor" practice using a very specific and detailed approach in providing chiropractic care.
Many Patients have avoided surgeries under DC Brad Glowaki's care and have been shown techniques to ensure a healthy lifestyle beyond their initial complaint.
Are you concerned about how Obamacare will affect chiropractics? Come to the meeting to find out more information!
We would like to extend a special invitation to our colleagues in Santa Clarita District. We know the drive can often be difficult because of the traffic to reach Northridge. We've selected a location that is in the middle of our districts and we would be honored if you would join us at this upcoming district meeting.
Our meeting is sponsored Albert Abkarian & Associates and University Imaging.
IMPORTANT ALERT!!!
CCA is challenging CIGNA’s requirement for pre-treatment authorization after the first five visits from ASH of covered chiropractic care by non-participating doctors of chiropractic under the PPO plan. CCA is working with the California Department of Insurance to investigate this matter, which may also involve Aetna, Anthem Blue Cross and Blue Shield, as each has apparently hired ASH to administer their PPO plans. More specifically, CCA is alleging:
- Plan members: The pre-treatment authorization requirement in effect changes the PPO benefit, for which policyholders and plan members are paying more in premiums, out-of-pocket co-pays, deductibles, etc., to an unlicensed HMO benefit.
- Non-participating doctors of chiropractic: The imposition of the pre-treatment authorization requirements essentially attempts to bind non-participating doctors to a contract. Further, the policy change forces these doctors to comply with the pre-treatment authorization regimen imposed not by CIGNA, but by a third-party administrator.
- Deceptive advertising and practices: By imposing pre-treatment authorization requirements on its PPO plan for non-participating doctors of chiropractic, CIGNA is effectively engaging in both deceptive advertising and deceptive PPO plan chiropractic benefit delivery. CIGNA holds out to employers and plan members that it is selling and providing a PPO benefit when, with the pre-treatment authorization policy change, it is providing an unlicensed HMO benefit.
The department is requesting written evidence from doctors of our concerns that this requirement exists, and that it requires the filing of paperwork with ASH, might result in delay of payments, denial of care, denial of a CPT code, etc. We are in need of evidence now to prove our positions. Below is what the department is requesting from aggrieved doctors:
- Complete the Department of Insurance "Request for Assistance," i.e., complaint, form (ensure all requested information is provided). The form can be found at http://www.insurance.ca.gov/contact-us/0200-file-complaint/upload/CSD012RFA.pdf
- The following documents to be submitted, if applicable:
- Copy of the patients’ (signed) Assignment of Benefits, if applicable
- Copy of the claim forms submitted to the insurance company (UB, CMS 1500, etc.)
- Copies of all correspondence between the provider and the insurance company, including all related EOBs
- Copy of the Dispute Resolution Process determination letter
- Copy of the patient’s insurance identification card- both sides
- Copy of the provider’s contract with the insurance company, if any.
- Provide on a separate document an explanation on how you were notified about the required review after the fifth visit (or any other issues). Please specify whether a letter was received (please also attach letter) and whether it happened before or after the fifth visit and also if it was denied (include the reason and denial letter). Please be specific as possible.
- Provide the following information: Policy number, certificate, name of insured with the complaint form (because this is a regulatory investigation, it is not necessary to protect the name of the patient, dx, etc.
The above may seem like a lot but the information is absolutely vital for the state Department of Insurance to investigate. As to concerns that doctors might encounter retribution, this is a state investigation. I believe that if the doctors who assist find the carriers treat them differently, i.e., negatively, we would go back to the DOI to get it stopped. Surely DOI know those doctors were part of the investigatory process and will have no tolerance for carrier retribution. Please e-mail or fax the materials to Michelle Bancroft at CCA at mbancroft@calchiro.org or 916-648-2738 or contact her if you have questions.
Necessary Files
Bills Signed Into Law By Gov. Brown
| SB 540 modifies B & P code 651 SECTION 1. Section 651 of the Business and Professions Code is amended to read: 651. (a) It is unlawful for any person licensed under this division or under any initiative act referred to in this division to disseminate or cause to be disseminated any form of public communication containing a false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering of professional services or furnishing of products in connection with the professional practice or business for which he or she is licensed. A "public communication" as used in this section includes, but is not limited to, communication by means of mail, television, radio, motion picture, newspaper, book, list or directory of healing arts practitioners, Internet, or other electronic communication. (b) A false, fraudulent, misleading, or deceptive statement, claim, or image includes a statement or claim that does any of the following: (1) Contains a misrepresentation of fact. (2) Is likely to mislead or deceive because of a failure to disclose material facts. (3) (A) Is intended or is likely to create false or unjustified expectations of favorable results, including the use of any photograph or other image that does not accurately depict the results of the procedure being advertised or that has been altered in any manner from the image of the actual subject depicted in the photograph or image. (B) Use of any photograph or other image of a model without clearly stating in a prominent location in easily readable type the fact that the photograph or image is of a model is a violation of subdivision (a). For purposes of this paragraph, a model is anyone other than an actual patient, who has undergone the procedure being advertised, of the licensee who is advertising for his or her services. (C) Use of any photograph or other image of an actual patient that depicts or purports to depict the results of any procedure, or presents "before" and "after" views of a patient, without specifying in a prominent location in easily readable type size what procedures were performed on that patient is a violation of subdivision (a). Any "before" and "after" views (i) shall be comparable in presentation so that the results are not distorted by favorable poses, lighting, or other features of presentation, and (ii) shall contain a statement that the same "before" and "after" results may not occur for all patients. (4) Relates to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully and specifically disclosing all variables and other material factors. (5) Contains other representations or implications that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived. (6) Makes a claim either of professional superiority or of performing services in a superior manner, unless that claim is relevant to the service being performed and can be substantiated with objective scientific evidence. (7) Makes a scientific claim that cannot be substantiated by reliable, peer reviewed, published scientific studies. (8) Includes any statement, endorsement, or testimonial that is likely to mislead or deceive because of a failure to disclose material facts. |
Our CE meetings were a hit! Thank you to all in attendance, and check out the photos here.
CALIFORNIA CHIROPRACTIC BOARD ADOPTS INFORMED CONSENT REQUIREMENT FOR CHIROPRACTORS
With the recent adoption of new informed consent requirements for California chiropractors, the California Board of Chiropractic Examiners has joined the ranks of only a few chiropractic regulatory agencies in the nation to require its licensees to inform patients of potential risks of their treatment. The new law, which goes into effect on October 7, 2011, requires chiropractors to obtain patient consent prior to providing any treatment that could pose a risk of harm to the patient. Specifically, this regulation will:
· Require all licensees to inform each patient, verbally and in writing, of the material risks of proposed care.
· Define “material” as a procedure inherently involving known risk of serious bodily harm. Require the licensee to obtain the patient’s written informed consent prior to initiating clinical care.
· Provide that the signed written consent shall become part of the patient’s record.
· Specify that a violation of the above requirements constitutes unprofessional conduct and may subject the licensee to disciplinary action.
"The BCE has been working diligently to improve the standards of care in the chiropractic profession in California,” said Fred N. Lerner, D.C., Chair of the BCE. “The BCE’s primary mission is consumer protection, and these new regulations are part of the Board’s ongoing effort to ensure patient safety. Informed consent is considered a standard of care in the chiropractic profession and this regulation reinforces that standard. The informed consent process ensures that the patient’s right to self-determination regarding health care is paramount.”
The BCE continues to work with stakeholders on other regulations to improve patient safety and consumer protection.
Please visit the BCE’s website www.chiro.ca.gov for information regarding existing and proposed regulations. To receive timely information concerning upcoming meetings and new and proposed laws. Join the Board’s E-mail List at the following link: http://www.chiro.ca.gov/onlineservices_subscribe.htm
New CCA Group Health and Dental Insurance Program Unveiled
CCA is excited to announce the endorsement of a group health and dental insurance program brokered by longtime CCA broker of endorsed workers’ compensation, business and personal lines of insurance, Warren G. Bender Co. Now, CCA members can potentially improve their coverage and reduce their premiums health and dental insurance.
This CCA member exclusive and unique group health and dental insurance programs offer:
· Unlike individual coverage, group health insurance cannot be denied for pre-existing conditions
· Coverage available for groups as small as two (and in some regions even one participant is sufficient)
· With one phone call, you'll have access to dozens of group plans, ranging from very broad to high deductible programs
· Bender will scour the marketplace for the group health and dental plan that meets your needs and budget, including Aetna. Blue Cross, Blue Shield, Ameritas, Colonial, Delta, HealthNet, Kaiser, MES, Met-Life, Premier Access, Principal, UnitedHealthcare, Western Health Advantage and more
· Bender proactively alerts you to changes with the carriers and keeps you informed regarding the benefit plans with the best value.
· Bonus: CCA members who purchase the CCA-endorsed group health insurance will have access to a comprehensive on-line resource to California employment and labor law tailored to small businesses for $4 per month (retail value at $1,100 for the first year). For groups of 5 or more, this HR resource will be absolutely free!
Learn more about all of the lines of CCA-endorsed insurance products brokered by Warren G. Bender – workers’ compensation, businessowner’s, disability, office liability, and home and auto by visiting Bender’s booth at the free CCA Annual Convention & Exposition, June 10-12, in Reno, or call 877-WGBENDER (942-3633).
Return on Dues Investment: Based on actual policies written for CCA members, members can save from 50 to more than 100 percent of their annual dues investment on individual coverage for home, automobile, and business coverage for workers’ compensation, disability or office liability and group health products endorsed by CCA and brokered by Warren G. Bender Co.
Do you know all the requirements to keep your chiropractic license up to date? Check out this flyer for all the details on how many CE hours are required for license renewal.
ACA Aggressively Pursues Concerns with ASHN
The American Chiropractic Association (ACA) continues to aggressively pursue its advocacy efforts on behalf of doctors of chiropractic against certain chiropractic managed care networks. Based on concerns received from many states across the nation since fall 2010, American Specialty Health Network (ASHN) is one of the most frequently identified offenders. According to reports, ASHN has created chaos for providers and patients by not thoroughly vetting its business arrangements through state Departments of Insurance and by implementing egregious practices such as those that would impose in-network type management upon out-of-network providers. In some states, employers were reportedly not notified that ASHN would be managing their employees’ chiropractic benefits. In others, the insurer, even after the agreement to bring on ASHN, was unaware of the policies under which providers would be managed. The overall confusion from these practices has caused patients, providers and employers to become very concerned.
To date, the ACA has received complaints of the following:
- lack of clear communication to providers, patients and employers resulting in coverage and payment errors;
- unwillingness to resolve confusion of patients and providers by coordinating services with payers;
- restriction of treatment not in keeping with standard chiropractic practice;
- disregard of state statutes;
- interfering with doctors’ duty to exercise professional clinical judgment in managing patients’ treatment plans;
- lack of appropriate, evidence-based clinical rationale for denial of treatment;
- untimely payment of claims.
The ACA recommends that
providers contact their state Department of Insurance to make the voices
heard on behalf of their patients. Resources to help providers can be
found at the ACA Chiropractic Networks Action Center here: www.acatoday.org/cnac.*
All providers are strongly
encouraged to contact and/or send documentation to the ACA explaining
the problems being encountered by calling (703) 812-0225 or by emailing insinfo@acatoday.org.
The ACA is committed to advocating on behalf of providers and patients, and to halting the abuses that impede appropriate patient care, and fair, equitable and timely provider reimbursement.
*Check the CNAC webpage often as this page is frequently updated.
New law increases the annual license renewal fee from $150 to $250. New BCE regulations require licensees who have either not previously submitted fingerprints to the BCE, or who were initially licensed prior to January 1, 1997, or for whom a record of an electronic submission of fingerprints no longer exists, to submit fingerprints electronically. Licensees are required to comply by the licensee’s renewal date that occurs on or after June 1, 2011.
It was been an honor having Dr. Dale Fernandez serve as president of the board for the San Fernando Valley District. Dr. Fernandez has served on the board for the past two years and was recently awarded “The 2011 Doctor of the Year.” Since Dr. Fernandez has been in office he has overseen some great accomplishments. A significant update to the San Fernando Valley District website now includes a research library and very efficient means of distributing information to the district. Additionally, a shift in the presentation and delivery of the monthly newsletters has taken place. Dr. Fernandez, has also led and organized many district meetings.
We will still have Dr. Fernandez serving the district on the CE committee. This new committee will be charged to bring a CE courses directly to the district. (Please visit CCAmembers.com to find out more information about the upcoming CE course). Dr Fernandez will also continue to treat patients at his Valley Village practice.
Thank you Dr. Fernandez!
A Response From Congressman Adam Schiff
We recently sent you a very important news item regarding our Veterans (see below). A bill was introduced by Bob Filner called “Chiropractic Care to All Veterans Act” (H.R. 329) that would require the VA to staff their hospitals with DC at all major Veterans Hospitals by 2014.
Eric and Pat Mumbauer got in contact with the Honorable Congressman Adam Schiff, who is a long time supporter of the CCA and friend to the San Fernando Valley District. Congressman Schiff responded with the following letter:
Hey Pat,
Thanks so much for your email. I would be proud to cosponsor H.R. 329 (Chiropractic Care Available to All Veterans Act) which will amend the VA Health Care Programs Enhancement Act of 2001 to require a program under which the VA provides chiropractic care and services to veterans through VA medical centers and clinics. The bill also includes chiropractic examinations and services within required VA medical, rehabilitative, and preventive health care services. I have asked my staff to add me to the bill.
I also want to let you know that I am co-sponsoring HR 409 (Chiropractic Health Parity for Military Beneficiaries Act) that directs the DoD, no later than August 31, 2011, to complete development of a plan to provide chiropractic health care services and benefits, as a permanent part of the TRICARE program (a DoD managed health care program), for covered beneficiaries. Please give Eric my best, and thanks for the heads up!
My best,
Adam
You are the CCA! We stand together and work toward a common goal. Bills like H.R. 329 help ensure the future of our practice as well as get treatment to our honored Veterans. With the CCA we have the power to reach out and work with our elected officials. Thank you for your continued membership with the CCA.
Help Advocate for Expanded Access to Chiropractic for Our Veterans
Rep. Bob Filner (D-Calif.), recently introduced the Chiropractic Care to All Veterans Act (H.R. 329), a bill similar to legislation that was overwhelmingly passed by the House in 2010, but was not considered in the Senate. H.R. 329 would require the VA to have a chiropractic physician on staff at all major VA medical facilities by 2014. You too can help ensure chiropractic care is available to the brave men and women who have served our country. H.R. 329 needs cosponsors to increase the likelihood of this effort's success. Simply click here to urge your legislator to cosponsor H.R. 329!