Chiropractors complain about HMSA payment changes

HONOLULU (HawaiiNewsNow) – Hawaii chiropractors are protesting new policies by the state’s largest health insurance company, saying the changes are costing some practices tens of thousands of dollars a month and could force some out of business.

Read more First Hawaiian Bank to acquire Tri Counties Bank

HMSA warned chiropractors in April that they would be subject to new treatment review policies, but providers say the scope of the changes — and the financial impact — caught many off guard.

Denied claims adding up

Turning Point Chiropractic in Kaimuki, one of Hawaii’s largest chiropractic practices with 17 practitioners, began seeing charges denied for services like follow-up exams after HMSA announced the new policies.

“They’ll pay for a few visits, and then all of a sudden, stop paying for the visit,” said chiropractor Joseph Leonardi, D.C. “So it’s a consistency issue at this particular point, and it really is negatively impacting our patients.”

Dean Shivvers, president of the Hawaii State Chiropractic Association and owner of Turning Point Chiropractic, said the denied charges have added up to $100,000 a month in lost income at Turning Point alone.

“We’re talking significant losses, but, like, not just us, but other practices as well,” Leonardi said. “And sometimes it may be even more impactful in a smaller office.”

Leonardi said many chiropractors have expressed concerns that they may not be able to stay in practice.

Read more Green signs law raising pay for Hawaii public school teachers

Lawmakers raise provider shortage concerns

State Rep. Scot Matayoshi, who chairs the House Consumer Protection Committee, said chiropractors are an important part of Hawaii’s overall health care system — one in which HMSA holds significant influence.

“We’re at such a provider shortage already that these big changes, if they rock the boat too much, could lead to an even greater doctor shortage than we already have,” Matayoshi said.

HMSA statement

In a statement, HMSA said: “HMSA’s goal is to ensure that our members have access to care that is appropriate, effective, and aligned with evidence-based clinical guidelines. The physical medicine program was updated to give us a more consistent way to review chiropractic care, occupational and physical therapy, and assess whether they support better health outcomes.”

The new assessment process has also meant more paperwork for patients and, in some cases, delays in coverage determinations.

“There are weeks, and a patient is like, ‘Do I have insurance? Am I covered? Is this — am I responsible for this?’” Leonardi said.

Chiropractors said they were encouraged when the governor intervened to stop a separate HMSA plan to change the payment structure for physicians. They said they hope someone will step up for them as well.

Read more H-1 lane reopens after crews weld drain grate back into place