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TCA Meets With Texas Department of Insurance
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Each quarter the TCA meets with the Texas Department of Insurance to review with each other what is occurring within the respective professions.  On June 3, 2010, representatives from the TDI met with the leadership of the TCA.  The TDI provided an update on insurance complaints received from doctors of chiropractic.  They report that in 2009 there were 100 health insurance complaints from chiropractors and that more than $10,000 were returned to D.C.s as a result of using the insurance complaint process.  Thus far in 2010, not quite half of the year, TDI has received only 6 insurance complaints and has returned more than $500 to D.C.s.  The Workers' Compensation Network side reported no complaints from chiropractors thus far this year, though the Department of Workers' Compensation reported 28 complaints thus far this year and has returned more than $6,604 to D.C.s

The TCA reported to TDI that a large self-insured employer may be denying certain services provided by chiropractors. More information will be gathered and reported to the TDI.  Regarding TDI's regulatory authority over self-insured plans, TDI does not regulate the benefits offered by self-insured plans, but TDI does contact carriers regarding complaints from consumers and providers about claims filed under self-insured plans.  In many cases, the plan states they will contact the policyholder directly; in other cases, the plan responds to TDI about the issues raised in the complaint.  They report that more information regarding DWC complaints may be found at http://www.tdi.state.tx.us/wc/pbo/index.html.

The TDI Reports "The DWC Performance Based Oversight (PBO) Working Group meetings are ongoing; Dr. Jeff Cunningham is TCA's representative.  DWC anticipates that health care provider performance measures will be announced this month with notification letters to go out by July 1.  Possible measures include completeness of the Work Status Report, timeliness of release to return to work, timeliness of DWC 69 reports, and MRI usage.   Preliminary information indicates no chiropractors are to be assessed.  For more information, please visit the PBO web page at http://www.tdi.state.tx.us/wc/pbo/pbo.html."  

Further, the TDI reports "DWC is hosting the 2010 Annual Educational Conference in Austin on July 19-21 and in Dallas on August 2-4; for more information, please visit http://www.tdi.state.tx.us/wc/events/conference10.html.  Amy Rich, DWC's provider ombudsman, provides assistance and training to health care providers and their staff.  She has provided training sessions in 19 Texas cities this year.  Amy also provides a free, "virtual" training via conference call and Internet using DWC web pages; this format is great for a provider's office staff.  To schedule a training, please contact Amy at 512-804-4809.  More information for WC providers may be found at http://www.tdi.state.tx.us/wc/hcprovider/compconnection.html or providers can call CompConnection at 1-800-372-7713."

Insurance products with separate deductibles and copays for each service provided was discussed and specific examples of these claims are requested by the TDI.  Chiropractors are welcome to send inquiries and complaints to Valerie Brown, Director, Complaint Resolution - Consumer Protection, at valerie.brown@tdi.state.tx.us.  Valerie's direct phone number is 512-463-6503.  A recent court decision on HB 148 is being watched and discussed to determine the effect of leaving accident victims' phone numbers off of police reports.

The TDI and the TCA will meet again in September.
 
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U.S. government overpaid private insurance companies administering Medicare Advantage plans by as much as $3.1 billion in 2010, according to a new report from the Government Accountability Office (GAO).

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