A group of Carson, Douglas and Dayton area chiropractors charged Thursday that the third-party administrator who handles claims for the state benefits plan is systematically trying to cheat them out of payments.
Lisa Getas told the Public Employees Benefit Program board that Benefits Planners is systematically delaying, challenging and denying legitimate claims. She said the pattern is the same according to numerous chiropractors in the area.
According to Getas, the company first asks for more information about a case. Then, when that information is sent, she said they claim it was never received. When it is resent, often by fax, she said they again claim it was never received, then they advise the patient his or her benefits are being delayed because the chiropractor hasn't provided necessary information.
Benefit Planners then advises the chiropractor that benefits have been denied after review by another chiropractor who ruled they aren't covered. And finally, she said, when they do end up paying, they have, since June, paid less than half the amount they did in previous years for each treatment.
Ann Steinberg of Dayton said a $36.50 treatment a year ago now gets reimbursed just $23.50, as an example.
Stuart Pardee of Minden and Vinson Christenson of Gardnerville said they, like several others in the room, have had upward of 80 percent of their claims denied in the past year.
"It's been getting progressively worse," Christenson said.
Pardee added the new fee schedule imposed this summer pays him less per treatment than he was getting 21 years ago - and less than Medicare, which he said is notorious as the lowest paying medical provider.
Charles Lowe of Benefit Planners said many of the concerns were being addressed and that a new system was being instituted to make sure letters carrying patient information don't get misplaced.
But James Hamtak of Carson City said they aren't being misplaced. He said his staff faxed one patient record to Benefit Planners while on the phone with them to confirm it got there. Yet three weeks later, he said, they claimed the documents never arrived.
"It's not just being misplaced. They're lying," he said.
Dublin Hart of Minden said the situation was becoming serious, with her and other chiropractors carrying claims for some patients more than a year.
"We have not been paid," she said. "This is willful and premeditated. It's illegal."
She said if Benefit Planners doesn't fix the situation and start paying, chiropractors will have no choice but to make changes in how they do business or move elsewhere.
"Life's going to get really ugly," she said.
Several of the chiropractors said it's most unfair to the patients who, under the terms of their plan, are entitled to the medical care. But more than one said if something doesn't change to get them the payments they have earned, they may have to put state patients on a cash basis.
Lowe said he could not comment to the press on the company's position.
Benefits board Chairman Teryr Johnson said he would look into bringing the issue to the board. Several members of the committee indicated they expect the issue to return for action if necessary. But the committee couldn't take action Thursday because the issue wasn't on the agenda, and to do so would have been a violation of the state's open meeting law.
Contact reporter Geoff Dornan at nevadaappeal@sbcglobal.net or 687-8750.
