California Insurer To Pay Less For Therapies

Published: Tue 22 Dec 2009

Wendy Blair

Upcoming changes announced separately by Blue Cross of California and Blue Shield of California have had many people seeing red.

Blue Cross has contacted physical therapy, occupational therapy, and speech therapy providers in its network to inform them that reimbursements for services will be reduced. Also, it will raise the employer costs for purchasing employee coverage.

Starting Feb. 1, Blue Cross will pay a maximum of $75 per patient visit without consideration of type of service provided. Depending on the facility, the cap means reimbursements will be trimmed 25 percent to 200 percent. The insurer delivered the news to its service providers in a letter stating the company hoped "these changes will be viewed by our therapy providers as exciting and positive."

At least they were told about it. So far, subscribers ranging from individuals to unionized workers haven't been contacted about the change in benefits.

This group of affected service providers offers a range of care. For example, physical therapists can help in the recovery process of surgeries, strokes, car accidents and war wounds. Speech therapists can help in developmental delays among children.

Such specialized, one-on-one care by highly trained professionals in well-equipped facilities is not cheap. With the $75 cap on reimbursements, some private facilities may close their doors because operational costs would be too high.

For those facilities that do remain, personal service could take a big hit. That could mean more time between appointments, no choice of therapists, inferior facilities and staff members who are willing to work for lower wages but are poorly trained.

Blue Shield of California sent its own letter to individual health insurance policyholders stating grace periods for payments were a thing of the past. The company "will no longer reinstate policies that are canceled for nonpayment of premiums," the letter read. "This means if your premiums are not paid in full and received by the due date, your policy will be canceled and you will need to re-apply for coverage."

This time, however, customers had their own response and the insurer listened. Blue Shield said it rescinded the plan. On its Web site, the company posted the announcement that "in light of the feedback we have received from our members about this issue, we are going to maintain our existing policy - nothing is changing."

The statement went on to say, "We will continue to allow canceled members to ask to be reinstated for an additional 15 days after the 28-day grace period. We will grant such reinstatements up to twice a year."