Article - June 13, 2008 - Pittsburgh Post

Highmark collection system leads to feud with providers

By Bill Toland

A midstate chiropractor says he was forced to close his doors because of an ongoing financial feud with Highmark Inc., stemming from the health insurer's system for collecting money from doctors who, in Highmark's eyes, provide excessive or unwarranted care.

While his case is extreme, other Pennsylvania chiropractors are telling similar stories, saying Highmark has retroactively reneged on hundreds of thousands of dollars in reimbursements, forcing the chiropractors to come up with the cash if they want to stay in Highmark's good graces.

At the heart of the dispute is Highmark's system of auditing providers months or even years after it has already approved and paid for care. Insurers nationwide say that such vigilance is needed to cut down on fraudulent chiropractic billing and reduce the overall cost of care. Chiropractors say they're easily bullied because, unlike physicians or other specialists, they're often not affiliated with deep-pocketed hospitals.

Either way, it's a practice that is being utilized more than ever.

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