The
following are informative minutes of the
The meeting was called to
order at
Motion: Moved by Bronston,
seconded by Masche to approve the minutes of the
Motion: Moved by Bronston,
seconded by McMahon to move into executive session. Motion carried.
Motion: Moved by Masche,
seconded by McMahon to move out of executive session. Motion carried.
Supreme Court
The board discussed two
important Supreme Court Cases. The first, involved the decision by the court
that chiropractors had the same duty as medical doctors to inform their
patients of the risks of care (see August
WCA Health Insurance
The board reviewed the decision
to switch its employees to an HMO plan which will save the association almost
50% of its health premium.
Insurance Commissioner
The board discussed two
complaints filed with OCI.
The first deals with a number
of complaints from our members on
the position of WEA Insurance regarding when one of their insureds is eligible
for an independent review. WEA does not allow their insureds to have access to
an independent review if they do not have out of pocket expenses related to
services that have been denied. WEA’s position is contrary to WI. Stat.
632.835(2)(b).
The statue does not provide
an exemption when an insured does not incur out of pocket expenses as a result
of the adverse determination.
The intent behind the law was
to allow insureds and their providers an opportunity to seek an unbiased
independent review whenever the cost or expected cost of the denied treatment
exceeds, or will exceed $250. As a result of their policy, WEA reviewers can
arbitrarily limit care without allowing the insured or their provider to
challenge the credibility of the review. The insured is intimidated from
receiving care which may be essential to their full recovery.
The second is a continuing
dispute with Humana and the methods they use to determine
the maximum allowable amount
they will pay for a service. We supplied OCI with information that confirmed
that Humana did not base its fees on a properly constructed data base.
The WCA has requested a
meeting with OCI to discuss both issues.
Chiropractic Compass Best Practices Document
The board reviewed the WCA’s
plans for expediting the review of the best practices document when it is
expected to be released early next year. The emphasis of the WCA will be to
solicit comment from the members, and to have the comments immediately
forwarded to the authors of the document so that revisions may be made to the
final document. The exact date of the relase fo the document is not yet known.
Motion: Moved by
Motion: Moved by Bronston,
seconded by Masche to come out of executive session. Motion carried.
The meeting was adjourned
approximately