resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
May, 2001, Vol. 01, Issue 05
Washington State Massage Therapists Win Again
Regence BlueShield Agrees to $30 Million Settlement
By Editorial Staff
In 1995, Washington state showed its progressiveness in health care matters with the passage of an "alternative provider" statute (House Bill 1034), which required insurers to cover services provided by all of the state's licensed categories of health care providers, including: massage therapists; chiropractors; medical doctors; acupuncturists; naturopaths; physicians' assistants; registered nurses; and podiatrists.
Not surprisingly, days before the Jan.1, 1996 enactment of the bill, a dozen of the state's largest health insurers challenged the law in the courts. The outcome of the legal maneuvering was that in the spring of 1997, a federal judge in Tacoma declared that the bill conflicted with federal (ERISA) law barring state regulation of employer benefit plans.
During this litigious period, Regence BlueShield determined that the statute applied only to managed care plans, or those plans in which patients were required to go through a primary care physician for a referral to receive specialized treatment. Regence reportedly only allowed "managed care" patients to choose a naturopath as their primary care provider; this left most Regence subscribers, specifically those on the "indemnity" plans, out in the cold. Regence's strategy excluded alternative providers on approximately two-thirds of its plans, while offering limited coverage to the remaining one-third.
In June 1998, however, the U.S. Ninth Circuit Court of Appeals in San Francisco overruled the Tacoma decision and reinstated the law. The court ruled that federal law did not prevent a state from expanding health coverage to its residents. The court recognized that HB 1034 met the traditional tests for insurance matters and therefore fell within the state's jurisdiction.1
The Seattle law firm of Sirianni & Youtz was granted permission by the Ninth Circuit Court to present arguments in support of the state's position, and to uphold the laws on behalf of the Washington Association of Naturopathic Physicians and the Washington State Chiropractic Association in urging that the law be held valid and enforceable. Regence continued its policy of excluding and limiting alternative care.
Represented by Sirianni & Youtz, Dale Snow became the lead plaintiff in a class-action lawsuit in federal court against Regence. Claiming that Regence ignored the "every category" law, the suit charged Regence to reimburse its subscribers for the out-of-pocket expenses they incurred when receiving treatment from alternative providers.
This action was brought under ERISA, a federal law that governs health plans issued to employees by private employers. Snow and other Regence subscribers (now members of the class-action lawsuit) alleged that Regence failed to comply with the "every category of provider" law with respect to health plans governed by ERISA.
On February 22, 1999, the U.S. Supreme Court declined to hear an appeal by the insurance industry, rejecting their attempts to have the law overturned. The justices also let stand the decision of the Ninth Circuit Court.2
During that same year, Regence moved to dismiss the Snow et al. lawsuit as frivolous. Judge William Dwyer denied the motion, certified the lawsuit as a class action suit, and asked the Washington Supreme Court to decide whether the every category law required Regence to provide access to alternative providers on all its health care plans. Sirianni & Youtz argued before the Washington Supreme Court that the law requires Regence to provide coverage on all its plans.
The next attack on House Bill 1034 was issued in November of 1999 when Regence BlueShield accused the state's insurance commissioner, Deborah Senn, of interpreting the law too broadly. In their suit, Regence argued that the law should apply only to managed care plans in which a patient's health coverage is managed by a "gatekeeper," and that it should not apply to traditional insurance plans.3
The court unanimously rejected Regence's claims.The court decreed that the insurance commissioner's interpretation of the statute was "consistent with the legislature's intent" and pertained to managed care plans and all health care insurance plans offered by health care insurers. The court added that "every health plan offered by Regence (with the exception of basic health model plans)" is subject to the regulations contained within the alternative provider law.
In a unanimous January 2000 decision, the Washington State Supreme Court ruled in favor of Dale Snow et al. The court said that the every category law applied to managed and nonmanaged care plans alike.
Sirianni & Youtz then filed another class-action suit, Steven Holman v. Regence BlueShield, to pick up non-ERISA policies (for example, policies governed by state law, such as individual policies). A state court judge certified the case as a class action, and ruled that Regence must allow access to every category of provider on its state-law-governed policies. With this order, the federal and state actions were brought into alignment on the issue.
Effective March 1, 2000, Regence changed its policies and allowed its subscribers access to massage therapists and other alternative care providers as the Washington State Supreme Court ordered, but denied that it had any obligation to reimburse the class-action litigants for care received before March 1, 2000.
In July, Federal District Court Judge Marsha Pechman ruled in favor of the class members, finding Regence liable for past benefits wrongfully withheld from their subscribers since 1996 for care the subscribers received from massage therapists, chiropractors, naturopaths, acupuncturists and nutritionists. The amount of damages, and the method by which the class-action litigants will be reimbursed, had yet to be determined by the court.
In November, the parties agreed to mediate the damage issue before Judge George Finkle, a retired judge who provides professional mediation services. The parties could not agree on a lump sum of money Regence should pay, but they did agree on a process to determine that amount. An agreement was reached whereby the state and federal class-action suits were combined. An arbitrator, assisted by a PhD health economist, set the amount of damages Regence must pay. The class-action litigants and Regence presented evidence and testimony before the arbitrator and health economist in a contested arbitration trial.
On February 9, 2001, arbitrator Thomas Brewer awarded $30,400,000 to the combined state and federal class-action litigants for out-of-pocket expenses incurred by Regence subscribers for alternative care between January 1996 and February 2000.
In March, Sirianni & Youtz and Regence's attorneys asked the federal and state courts to approve and confirm the $30,400,000 award and approve a claims process.
Sirianni & Youtz has brought these and other class-action lawsuits designed to enforce the requirements of the "every category" law, and to recover damages for those people who have had to pay out-of-pocket for their alternative providers.
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