Millions of Highmark Customers to Lose Chiropractic, Physical Therapy Coverage on September 1st

Aug. 20, 2012 - PRLog -- New computer program will determine eligibility and treatments for chiropractic and physical therapy services – not doctors or therapists

Harrisburg, PA 8/20/12 – Millions of Americans insured by Highmark Inc. are about to have some of their medical treatments decided by a computer program, rather than their doctor or therapist, according to a professional healthcare association in Pennsylvania.  The Pennsylvania Chiropractic Association (PCA) today warned Highmark customers that the company is changing coverage for physical medicine services, which include chiropractic, physical and occupational therapy treatments starting September 1, 2012.  Healthcare consumers and professionals are urging the state insurance department to prevent the controversial program from being implemented.

Highmark’s usage of the new software program, known as the Physical Medicine Management Program (PMMP), is at the heart of the devastating changes being made by the insurer.  The computer program will begin making the treatment decisions for patients, rather than the doctor or therapist who actually examined the patient and made the diagnosis.

“This is a chilling snapshot of the future of healthcare in America, and one of the most egregious violations of a patient’s right to choice as we’ve seen,” said Dr. Daniel Schatzberg, President of the PCA, which represents more than a thousand chiropractors in Pennsylvania.   “Doctors and therapists who are actually seeing the patient will no longer have control over that patient’s treatment.  Instead, a computer algorithm will decide if a patient is even eligible for treatment, and if they are, how and when they will be treated.  ‘1984’ has truly come to healthcare, thanks to the questionable business practices of Highmark.”

Highmark’s use of the unproven and troubling evaluation plan was made without consumer input or regulatory or legislative oversight, even though a test program being used in Massachusetts has failed miserably.  Pennsylvania state legislators and the state insurance commissioner have been completely silent on the issue and no official efforts have been made to stop the company from implementing the program.  
“On September 1st, Highmark customers who rely upon chiropractic or physical or occupational therapy treatments will suddenly find their cases being analyzed by a computer software program,” said Dr. David Novatnak, a leading official with PCA who has headed the group’s opposition to the Highmark program.  “Millions of Americans are about to lose or have their access to these important types of treatments severely restricted.  This will have a devastating impact on both their quality of life and economic productivity.”

“Ultimately, millions of people will be forced to live with greater pain and discomfort, or be forced into more expensive drug or surgical solutions for their maladies, which not coincidentally generate far higher profits for Highmark.  So too will thousands of chiropractors and physical and occupational therapists be forced from their careers because of Highmark’s new PMMP,  just so the company can add to its existing $3.7 billion in cash reserves,” noted Novatnak.  

Schatzberg and Novatnak urged Highmark customers in Pennsylvania who depend upon chiropractic or physical therapy services to immediately contact their state legislators and the office of state insurance commissioner Michael Consedine to express their opposition to the Highmark PMMP plan.  

Contact the Insurance Commissioner at:
The Honorable Michael Consedine, Commissioner
PA Department of Insurance
1326 Strawberry Square
Harrisburg, PA 17120
Tele: (717) 783-2005
E: ra-in-commissioner@pa.gov