Why We Are Out of Network

oonWe just recently learned that, starting Monday, August 15, 2016, we will no longer be in-network providers with Blue Cross Blue Shield. This has come as a complete surprise to us and we apologize for the short notice, as we were only able to confirm this change of status on Thursday afternoon. Our staff has been working hard to notify the patients scheduled for next week who will be affected by this policy change. In many cases there will be very little difference in the out-of-pocket costs, but the processing of your claims will be slightly different. Please read the information below. It will help you understand how we came to our decision to withdraw, as well as explain why some of you were not notified until now.

On June 12, 2016, 1st Choice Sports Rehab Center withdrew from participation in a third-party company that processes chiropractic claims for many major insurance carriers.

We were told by each of these insurance companies that our withdrawal would only affect the third-party company policies and none of the other plans. A few weeks ago, some patients with state and federal Blue Cross plans received letters stating that the doctors at 1st Choice Sports Rehab would be withdrawing from the network after August 12.

Originally we believed this was a clerical error. Over the past three weeks we have made numerous attempts to clarify this directly with Blue Cross. It wasn’t until Thursday afternoon that we were able to reach a representative who informed us that withdrawing from the third-party processing company also forced us out of the network for all other plans. This has been a complete shock to us, since it was not what we were originally told.

Why we withdrew from the network processed by the third-party processor

Our primary goal has always been to provide our patients with the most effective evaluations, manual techniques and therapies, such as Active Release Techniques, (ART), Graston, Fascial Distortion Model (FDM), fascial manipulation, piezowave, and cupping, as well as many other approaches. We feel, and many of you have experienced, that these techniques are extremely effective and constitute the reason we get the quick and efficient results you have come to expect.

As many of you know, these treatments are not typically available in most chiropractic or physical therapy clinics. The techniques require an extended period of time to perform. We have always gone above and beyond “the typical” to acquire these advanced skills and certifications and continue to invest thousands of dollars and hundreds of hours each year to learn and acquire other methods of treatment so that we may best serve our patients. It is simply not possible or practical to do the best that we can for our patients in a shorter time frame, nor are we able to provide these services at a lower cost than we already do.

Unfortunately, plans (processed through the third party) within the Blue Cross Blue Shield network will no longer reimburse for the additional time required to achieve the exceptional results that many of you have experienced and come to expect. After numerous phone calls and letters asking this third party to reconsider their position, they have refused to do so, leaving us no choice but to end our contract. Unfortunately, as we found out on Thursday, this withdrawal has also forced us out of all the other Blue Cross Blue Shield plans.

What does this mean to you?

For most of you, the out-of-pocket costs for care will not change; the only change will be the way your claims are processed. As out-of-network providers, insurance companies will not pay us directly, but will send a check to you depending on your benefits. We will either submit your claim, or provide you with the paperwork for you to submit yourself. Once it is processed and the deductible has been met, your insurance carrier will pay you directly. You will be asked to pay for your visit with us at the time of treatment, and it typically takes about 2-3 weeks for the insurance companies to process your claims and forward their payment to you. **You will still be able to use your FSA cards and HSA plans to pay for your visits.**

We apologize for the inconvenience this change might cause but hope you see that our original understanding was that this change would affect only a small percentage of the plans.

If you are currently under the care of one of our providers, you should be able to contact your Blue Cross Blue Shield representative at 1-855-397-9267 and ask for a continuation of care. Patients have shown us letters they received stating that they might be eligible to receive a continuation of care under the current in-network policy.

What you can do…

If you have any questions or comments for Blue Cross Blue Shield, please call the customer service number on the back of your card to express your opinion.

If you have questions about your particular policy benefits in or out of network, please call our office at 404-377-0011. Again, we are sorry for the short notice and appreciate your understanding. This came as a complete surprise to us as well. For those of you whom we have already spoken with, we thank you for the enormous support you have shown. Your support and loyalty are the reason we remain steadfast in our resolve to provide uncompromising care to resolve your injuries in the shortest time possible.