The Cranberry Eagle
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Article published December 5, 2012

Highmark change riles doctors
More paperwork required now

Kelly B. Garrett
Butler Eagle

A change in coverage by Highmark for chiropractic and physical therapy visits has doctors angry, confused and in a fighting mood.

Dr. Dave Novatnak, a chiropractor with the Pennsylvania Chiropractic Association, said Friday that the change in the number of visits the Pittsburgh-based insurance giant will pay for patients to see a chiropractor or a physical therapist was supposed to start Sept. 1, but because of the outcry from doctors and therapists across the state, that start date was pushed to Jan. 1.
It is in what Highmark is calling a soft implementation.
“We have tried to sit down and talk with Highmark, but that hasn’t gotten us anywhere,” Novatnak said.
The biggest problem chiropractors have with the Highmark change is that the company has a computer system that requires more paperwork from both the doctor and the patient.
That information is put into the computer, and by using what doctors call “secret algorithms,” the number of visits a patient is allowed to make is determined.
“It’s Orwellian,” Novatnak said.
Butler chiropractic Drs. Ram Parikh and Stuart Surkosky both are upset about the Highmark change known as the Physical Medicine Management Program.
Parikh said that a patient can petition Highmark to get more visits, but that may only result in three or four additional visits, which still may not be enough.
“At least 90 percent of fall patients need more than eight visits to recover, but the insurance company would rather have patients have surgery or take pain medications for their injuries,” he said.
Surkosky added that the Physical Medicine Management Program is already adding a strain to his administrative staff with the extra paperwork, and the program isn’t yet in full operation.
Part of the doctors’ frustration, Novatnak said, is that Highmark won’t explain the algorithm or how it works.
In addition, he said, the premium that the insurance company is trying to save through this program is only $20 per year per person “so its not really that big a cost savings for them.”
Highmark did not respond for this story.