Chiropractors Accuse Arizona State Regulators of Not Enforcing Law

PHOENIX – Arizona chiropractors on Tuesday accused state regulators of failing to require a major health insurer to provide promised coverage, resulting in inadequate reimbursements that are driving some out of business.

Blue Cross Blue Shield of Arizona's copay requirements are unreasonably high while the Insurance Department is not enforcing a law against discrimination in coverage for chiropractic care, the Arizona Chiropractic Association alleged.

The association called for Gov. Jan Brewer to either fire Insurance Director Christina Urias or make her go after Blue Cross Blue Shield. Urias was originally appointed by Gov. Janet Napolitano in 2003.

Association president Alan Immerman said Blue Cross Blue Shield puts a $44 limit on payment for a chiropractor visit and requires the patient to pay $40 of that amount. That causes some patients to skip getting treatment and deprives chiropractors of adequate compensation for treatment they do provide, he said.

A Blue Cross Blue Shield manager didn't dispute the specific cost figures cited by Immerman, but said coverage and payment provisions vary according to policies.

Janis Raynak, the insurer's director of litigation services, said Blue Cross Blue Shield covers medically necessary chiropractic services while trying to hold down rising health care costs.

"We believe chiropractors are an important part of care for people," Raynak said. "We're just trying to ensure it's delivered according to the contract and for every policy that we're not paying for things that aren't included."

Brewer said she wasn't familiar with the association's concerns and could not comment. Insurance department spokeswoman Erin Klug declined comment, citing pending litigation stemming from a lawsuit filed by chiropractors.

In a case now under appeal, a trial judge ruled that there weren't legal grounds to order Urias to enforce the anti-discrimination law. The department's lawyers have argued that Urias has discretion to act as she sees fit and that she concluded that Blue Cross Blue Shield hadn't violated the law.

Immerman blamed the insurance situation for causing 130 chiropractors to close their doors, the vast majority in the Phoenix area.

"This isn't insurance cover for chiropractic (care). It's a sham," Immerman said. "The problem is the consumer thinks they have chiropractic insurance."

The state board that regulates chiropractors said Arizona has approximately licensed 2,600 chiropractors and that the number has slipped slightly in the past two years.