How Florida Blue Changed the Rules

We still see our Blue Cross Blue Shield patients everyday. But the rules have now changed, unfortunately not in the favor of patient care. 

We at Dr. Dan Kirschner Chiropractic have been treating patients with Sports Injuries, Auto Injuries and Chronic Pain for nearly 40 years. During that time Dr. Daniel Kirschner, has developed a unique approach to care. He has attended post-graduate courses in functional movement diagnostics, low-level laser therapy, advanced manual therapy techniques, sport-specific evaluation and auto accident injury management. This allows Dr. Dan Kirschner Chiropractic to provide extremely effective care. Patients improve faster, and more completely because of this advanced training. This saves time and money for patients and insurance companies alike.

For years, the doctors at Dr. Dan Kirschner Chiropractic have been a Participating or Preferred Provider in many insurance plans. Insurance companies like Blue Cross Blue Shield, Aetna, Cigna and United Healthcare have all invited Dr. Kirschner and Kirschner Wellness be a member of their physician panel. This has traditionally meant that patients with those insurance plans were offered Dr. Dan Kirschner Chiropractic high level of care at discounted rates.

However, year by year small practices like Kirschner Wellness have been squeezed into accepting lower and lower rates and more and more restrictions on the care they can provide. Many small practices in Florida have been and will be forced to make tough choices in the coming months and years. Unfortunately many insurance companies are driven by profit or revenue and have recently begun to restrict services while at the same time raising rates. Kirschner Wellness will never sacrifice patient care to appease the insurance companies.

Over the last few years United Healthcare and Cigna have hired “middle-man” companies to manage their Chiropractic and Physical Therapy services. These third party companies have attempted to squeeze their own profits from patients’ premiums (the amount people pay monthly for their health insurance) and have enacted requirements from doctors which have made it impossible for Kirschner Wellness to stay on those plans. Patients with United Healthcare and Cigna have had to choose limited services at “in network” doctors or continue to get excellent service and quality treatment at Kirschner Wellness with “out of network” benefits.

Recently, Florida Blue (Blue Cross/Blue Shield of Florida) notified all of its “in-network” Chiropractors that it was breaking their contract and turning over all Chiropractic benefits to a “middle-man” company called American Specialty Health (ASH). And while Florida Blue continues to raise rates on its members, it appears they have become another insurance company to put revenues before patient care. Their schemes are apparently working since they operate with a $2.8 BILLION surplus, and are planning on transferring $1.6 BILLION to a “for-profit” company, instead of returning the money to the policy holders as reduced rates. Florida Blue is supposed to operate as a non-profit company with the mission of providing low cost health insurance to Florida residents. However, the CEO is paid nearly $7 million a year and they pay out over $5 million to politicians in Florida each year.

The new ASH contract would make it impossible for Kirschner Wellness to provide the same quality care that patients have grown to expect, and deserve. The policies of ASH require extensive paperwork to prove “necessity of care” and by reducing covered services Florida Blue, under ASH would shift a majority of the cost to the patient. With this new contract Florida Blue would often pay about $3.50 for each visit after the patient pays their portion.

Kirschner Wellness regrets that Florida Blue has chosen to break the contract that we have operated under for many years. However, we at Kirschner Wellness will not participate in an arrangement that takes advantage of patients while serving to raise revenues for Florida Blue. As of April 1, 2015 Kirschner Wellness became “out of network” for most Florida Blue plans. Dr. Kirschner will continue to file claims for patients and we will always deliver the best care possible. We have many payment options for our patients of all budgets. Please contact Kirschner Wellness for more information.

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