INDIANAPOLIS, Indiana -- The Indiana State Chiropractic Association (ISCA) reports that "after months of meetings and heavy-duty politicking," it has convinced the Midwest region of Anthem Blue Cross and Blue Shield to reverse its policy on neurostimulators, TENS, PENS, functional neuromuscular stimulation, microelectrical neuromuscular stimulation, microamperage stimulation, and interferential stimulation.
In a letter to the ISCA (please see letter), Clifford Waldman,MD, chairman of the Anthem Medical Policy Committee, states that "claims for the use of these devices will no longer be denied as investigational." The decision affects claims for fully insured accounts with Anthem Blue Cross and Blue Shield, but not those claims for federal government business administered by Anthem (e.g., TRICARE, Medicare, Medicare Risk, FEP).
While this is a wonderful victory for Indiana DCs and their patients, it is restricted to only Anthem Blue Cross and Blue Shield. Other state associations who are experiencing similar problems should contact Mr. Ed Treacy, executive director of the ISCA, to discuss how to wage similar battles in their states.
| February 5, 1999 Mr. Edward T. Treacy Dear Mr. Treacy: This letter is to inform you of a recent decision by the Midwest Region of Anthem Blue Cross and Blue Shield to change the current systems edits associated with Anthem Medical Policies #251 (neurostimulators, TENS, PENS, Functional Neuromuscular Stimulation), #255 (Micro Electrical Neuromuscular Stimulation, Microamperage Stimulation), and #256 (Interferential Stimulation). Beginning with dates of service of January 1, 1999, claims for the use of these devices as described in these policies will no longer be denied as investigational. This decision does not affect the application of Anthem Medical Policies #021 (Bladder Stimulation) or #117 (Pelvic Floor Stimulation). In general, this decision will affect claims for fully insured accounts with Anthem Blue Cross and Blue Shield. Please be advised that this decision will not affect claims for federal government business administered by Anthem (e.g., TRICARE, Medicare Risk, FEP). In addition, accounts administered by Anthem Blue Cross and Blue Shield that are not fully insured accounts may choose to continue to have these claims denied as investigational. This decision also does not affect any specific contract limitations or exclusions with respect to these devices and procedures. Lastly, we reserve the right to implement contract benefit limitations or other medical policies or utilization guidelines related to these types of claims in the future. We thank you for your input throughout this process. Sincerely, Clifford R. Waldman, M.D. |
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