dailey.jpg
Rob Dailey, a former Navy Corpsman who lugged 84 pounds of gear in Afghanistan, is treated for back and hip injuries by chiropractor Dr. Robert Haley, as part of a program that provided 60 visits of care free for veterans in 2011. The Association of New Jersey Chiropractors is suing the State Health Benefits Plan for discrimination, for arbitrarily limiting out-of-network reimbursements. (Robert Sciarrino | The Star-Ledger)
( )
TRENTON -- Chiropractors in New Jersey are waging a legal battle against a decision they say that could make thousands of public workers pay more for out-of-network treatment by cutting reimbursements 70 percent beginning in January.
The case stems from the decision by the State Health Benefits Commission in July to curb out-of-network care by slashing reimbursement rates to $35 a visit or 75 percent of the in-network rate, whichever is less.
The Association of New Jersey Chiropractors filed an appeal in September claiming their profession was unfairly singled out among other pain management specialists for drastic cuts.
A hearing on the case has not yet been scheduled, said Jeffrey Randolph of Glen Rock, the association's attorney.
Randolph said he has thousands of signatures on a petition from public employees across the state that reads: "This letter will serve as my formal opposition to the New Jersey State Health Benefits Commission discriminating against the chiropractic profession and their patients by restricting and limiting payment to chiropractic physicians for the upcoming 2016 Plan Year, negatively impacting New Jersey state workers that have Aetna and Horizon Blue Cross Blue Shield" of New Jersey.
"I don't have an exact count but the pile of signed petitions is about two feet tall," he said, including a photo of the documents.
RELATED: Ruling extends N.J. public workers' increased health care contributions
Randolph said he couldn't estimate what financial impact on the 20 percent of chiropractors in the state who have chosen to remain outside insurance plans.
"The true impact is on the patients who have to absorb the lion's share of what their insurer will not pay and many may drop out of needed care because of this," he said.
But David Jones, a member of the commission's Design Plan Committee and a retired member of the New Jersey State Police, defended the decision. He and his colleagues also voted to rein in costs of prescription drugs, hospital stays and emergency room visits at that July 6 meeting.
"There are multiple cost drivers in this inflationary madness of the current cost of health care in America," Jones said. "We have identified as many as we could on the committee, (because) we have an obligation not only to our members but to the state of New Jersey to get a handle what has been an out of control system."
Chiropractors should join insurance networks, or expect to "share in the pain,' he added.
State Treasury spokesman Christopher Santarelli declined to comment on the appeal. But he produced several cost-cutting resolutions unanimously approved by the committee that day. They include raising co-pays on emergency room visits, designing a plan with no out-of-network coverage, to requiring a less expensive Hepatitis C drug to be dispensed first before moving on to more expensive options.
The committee also voted to limit payment for out-of-network acupuncturists to $60 a visit or 75 percent of the in-network rate, whichever is cheaper.
They are part of a larger effort approved by the committee that will save $100 million, Santarelli said.
The decision affecting out-of-network chiropractors will save only $2 million of that amount, said Steven Clarke, a chiropractor in Nutley and chairman of the association's legislative committee. It also fits a pattern of discriminating against chiropractors, he said.
Of the 2,100 chiropractors working in the state, about 1,800 are in an insurance network, according to the association. The others resist joining or dropped out because of meager reimbursements and the constant battles with insurance companies.
MORE: N.J. slashes prescription costs for retired public workers
The association won a judgment for fairer reimbursement policies against Horizon in 2009, after the insurance "refused to pay for anything but a spinal adjustment" and instituted a 20 percent rate reduction, Randolph said.
"This time, the state targeted chiropractors, but they didn't place similar pay caps on physical therapists," Clarke said. "They do great work but you can't do one without the other," he added.
Clarke said he sees chiropractors saying the health system money by preventing costly procedures. It's also what many of their patients like police officers and firefighters want. "People come here because they don't want to use (pain) drugs."
"The sad fact is virtually none of them know that these changes are coming Jan. 1 and when they have to start paying even more, many will either have to pay more out their pocket or even worse, will discontinue important medically necessary care," Clarke said.
Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio. Find NJ.com Politics on Facebook.