Highmark delays pre-authorization program amid provider criticism


After Highmark said it would change its authorization process for certain therapy and chiropractic services, the insurer has received plenty of negative feedback from affected providers.

That's why Highmark has decided to delay the start of its Physical Medicine Management Program, which requires members obtain pre-authorizations to receive more than eight visits of physical therapy, occupational therapy and chiropractic services. Originally scheduled to take effect last fall and then postponed twice already, Highmark said it will formally launch the program April 30.

Until then, the insurer will enter a "soft implementation" period, during which it won't deny claims for chiropractic or physical therapy treatment deemed medically necessary, the Central Penn Business Journal reported.

"Based on regular and ongoing feedback with providers, Highmark wants to allow physical medicine providers (doctors of chiropractic, occupational therapists, osteopathic physicians, physical therapists and facilities) impacted by the program additional time to become accustomed to the guidelines and requirements of the program," Highmark said in a statement to the Pittsburgh Tribune-Review.

But chiropractors and therapists remain displeased with the pre-authorization program. One issue the providers have is that Highmark's computer system requires additional information and paperwork for both doctors and members.

What's more, they allege that patients seeking therapy for falls would have to pay out-of-pocket to receive adequate treatment under the new pre-authorization program. "At least 90 percent of fall patients need more than eight visits to recover, but the insurance company would rather have patients have surgery or take pain medications for their injuries," Ram Parikh, a chiropractor practicing in Pennsylvania, told The Cranberry Eagle.

To learn more:
- read the Pittsburgh Tribune-Review article
- see the Central Penn Business Journal article
- check out the Cranberry Eagle article

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