Harrisburg, PA (GistCloud) April 4, 2014 – On March 28, 2014, in the case of Pennsylvania Chiropractic Association, et al., v. Blue Cross Blue Shield Association, et al., Judge Matthew F. Kennelly, District Judge, for the United States District Court (Northern District of Illinois), granted the Pennsylvania Chiropractic Association’s (PCA) request for a permanent injunction to address Independence Blue Cross’ (IBC) inadequate notice and appeal procedures and practices regarding recoupment of paid benefits from chiropractors and other health care providers.
The PCA commenced this action in 2009, under the Employee Retirement Income Security Act (ERISA), and alleged that IBC violated, and continues to violate, notice and appeal requirements under ERISA in recouping payments from PCA members. Judge Kennelly determined that when IBC recoups payments from PCA members without adequate notice and appeal, IBC deprives them of monetary benefits along with information supporting the adverse claim determination and the right to an appropriate appeal. Judge Kennelly held that the PCA is entitled to a permanent injunction to address IBC’s ERISA violations. The PCA, through its attorneys, will be submitting a proposed form of injunction on or before April 11, 2014. IBC will file its reply and Judge Kennelly will ultimately decide the specifics of the injunction at a later date.
Commenting on the decision, Pennsylvania Chiropractic Association (PCA) President Daniel Schatzberg, DC, DABCO, called the court’s decision “a watershed moment for Chiropractic health professionals as we fight for fairness and transparency in health insurers’ increasingly aggressive and misdirected efforts to seek inappropriate recoupments from health care providers.” According to Dr. Schatzberg, “health insurers’ recoupment efforts, often times do not give the providers a fair process to appeal the insurers’ adverse decision, and this has had a devastating effect on many members of the PCA. Judge Kennelly’s decision represents an important step in ensuring that health insurance companies such as IBC are forced to comply with the law, not merely their self-serving interpretations of the law.”
Dr. Schatzberg closed by complimenting the legal team that represented PCA in the case. “For several years now, PCA has worked closely with Attorneys Brian Hufford and Jason Cowart, on these important legal issues. This decision is a testament to their dedication to their clients, their superior work ethic, exceptional legal acumen and their commitment to standing up to the health insurance industry. These attorneys not only do things right, but they also embrace doing the right thing. For that, we are profoundly grateful. PCA also thanks Barry Wahner, DC and Mark Barnard, DC, for testifying in Chicago on behalf of the chiropractic profession. Their testimony was extremely crucial and repeatedly deemed ‘credible’ in Judge Kennelly’s decision.”
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The Pennsylvania Chiropractic Association (PCA) is an IRS 501(c)(6) non-profit corporation that is Pennsylvania’s professional membership association for Chiropractors in the Commonwealth. With a long history of successful advocacy, PCA remains solely dedicated to the advancement of Chiropractic as a viable and cost-effective health care choice in Pennsylvania and throughout the USA.