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Re: ACN from Blue Shield

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ACN stands for the American Chiropractic Network if that gives you a clue.

They reduce reimbursement to the hilt so they can pocket more profits and when

you contact them for an increase, they seem to always be reviewing it. It

is highway robbery to the providers.

Bubba Klostermann OT, CVE, CEAS

CEO, WORK & REHAB

4546 South 14 th

Abilene, Texas 79605

phone:

fax:

email: bubklo@...

This e-mail and any files transmitted with it are the property of WORK &

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Then they (ACN) come to PT chapter meetings and discuss the " Significance of

Evidence base PT " I can teach pts. home exercise programs and get them out of my

office and show the least # of visits with the least # of procedures done to

them. They (ACN) are trying hard to convince Blue Shield that they are saving

them a ton of money meanwhile they are using a different (chiro) cunning

technique of using the word " Evidence " to convince PTs that they are doing

something wrong by doing 2 procedures and 2 modalities. PTs are gullible and

they seem to be listening to the PT ACN is using to convince other PTs.

What a game!

Hiten Dave' PT

-------------- Original message --------------

From: bubklo@...

> ACN stands for the American Chiropractic Network if that gives you a clue.

> They reduce reimbursement to the hilt so they can pocket more profits and when

> you contact them for an increase, they seem to always be reviewing it. It

> is highway robbery to the providers.

>

> Bubba Klostermann OT, CVE, CEAS

> CEO, WORK & REHAB

> 4546 South 14 th

> Abilene, Texas 79605

> phone:

> fax:

> email: bubklo@...

>

> This e-mail and any files transmitted with it are the property of WORK &

> REHAB, are confidential, and are intended solely for the use of the

> individual or entity to whom this e-mail is addressed. If you are not

> one of the named recipient(s) or otherwise have reason to believe that

> you have received this message in error, please notify the sender and

> delete this message immediately from your computer. Any other use,

> retention, dissemination, forwarding, printing, or copying of this

> e-mail is strictly prohibited.

>

>

>

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I was contacted yesterday by ACN to schedule an " intervention " training for my

clinic, on how to treat and manage my patients better. Basically they want us

to comply with how " they " want us to practice, which means the cheapest way

possible for them. What should we do as PTs to deal with this situation. Any

suggestions would be appreciated.

E. , DPT

Bodyscape Integrative Physical Therapy

Pasadena, CA

From: BI Shafer

To: PTManager

Date: Fri, 27 Oct 2006 06:53:05 -0700

Subject: ACN from Blue Shield

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<p>Has anyone had any interaction with this ACN group from Blue

Shield and <br>

doing all of the paperwork that they are now saying they require from the <br>

therapist and the patient? Just what our patients want to do is fill out <br>

3-4 more forms. I had an 45 minute phone conferance with a PT the other day

<br>

from the ACN (from my understanding they only have 1 PT on the project) <br>

telling me that the # of visits I use to treat my patients is over what the <br>

national average but the number of units I billed per patient was less than <br>

the national average. I am not really sure what they plan to do with this <br>

information other than begin playing musical PT's clinics, by sending all <br>

the patients to the clinic that has the least amount of visits and units <br>

billed per patient. I have not been doing all the paperwork and when I <br>

asked her what would happen if I didn't do it, she told me that Blue Shield <br>

would be informed and they would decide what to do.<br>

<br>

Just wondering if anyone else has had interaction with ACN and thier <br>

thoughts on process. If anyone has any great insight I would be most <br>

appreciative. Feel free to contact me directly at: <a

href= " mailto:barryhrma%40hotmail.com " >barryhrmahotmail (DOT) <wbr>com</a><br>

<br>

Barry, PT<br>

California<br>

<br>

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__<wbr>_<br>

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We deal with ACN through United Healthcare and I agree with Bubba regarding

highway robbery. Our patients really dislike filling out all ever

increasing forms that these insurance companies and HIPAA create for their

own job security.

We too have been told that we are going over the national average, which is

absolute hogwash. I believe that it is just a scare tactic that we must

abide by, because as I said before and I will say over and over again, the

insurance companies are in the driver's seat. We as providers used to be in

the passenger seat, then the insurance companies shoved us into the back

seat and now we are outside of the car completely, running to catch up. We

will never be able to win this game because we are playing with a bunch of

cheaters.

I know that this site is not to be used for us to complain but I must say

that unfortunately we have to do as we are told.

Barry, you are doing what you were told to do and there is no logical way to

bring understanding to it all. I was not aware that BCBS worked in

conjunction with ACN and you may not have been aware that United Healthcare

worked in conjunction with ACN as well. Maybe this is something that we all

will have to prepare for, the fact that other insurance companies will

choose to partner with ACN and we will have to be prepared for the paperwork

bombardment.

Diane

Valley Rehabilitation

Arizona

ACN from Blue Shield

Has anyone had any interaction with this ACN group from Blue Shield and

doing all of the paperwork that they are now saying they require from the

therapist and the patient? Just what our patients want to do is fill out

3-4 more forms. I had an 45 minute phone conferance with a PT the other day

from the ACN (from my understanding they only have 1 PT on the project)

telling me that the # of visits I use to treat my patients is over what the

national average but the number of units I billed per patient was less than

the national average. I am not really sure what they plan to do with this

information other than begin playing musical PT's clinics, by sending all

the patients to the clinic that has the least amount of visits and units

billed per patient. I have not been doing all the paperwork and when I

asked her what would happen if I didn't do it, she told me that Blue Shield

would be informed and they would decide what to do.

Just wondering if anyone else has had interaction with ACN and thier

thoughts on process. If anyone has any great insight I would be most

appreciative. Feel free to contact me directly at: barryhrma@...

Barry, PT

California

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Just to clarify for everyone.... ACN is a preferred provider network (PPO)

that is wholly owned by United Healthcare, but sold to many other

healthplans to help them control costs, including Blue Cross. It was

formerly called American Chiropractic Network before it was sold to United

Healthcare. The gentleman at the helm of this division is a chiropractor.

Their goal and business model is to control costs by using their own

clinical practice guidelines, also developed largely by chiropractors. They

are very committed to their own clinical and business model and are keenly

aware that they are in the driver's seat. Hope this helps to understand

who they are and why they do what they do.

Garry Woessner, MA, MBA, CAS

Woessner Healthcare Consulting Group

Minneapolis, MN

ACN from Blue Shield

Has anyone had any interaction with this ACN group from Blue Shield and

doing all of the paperwork that they are now saying they require from the

therapist and the patient? Just what our patients want to do is fill out

3-4 more forms. I had an 45 minute phone conferance with a PT the other day

from the ACN (from my understanding they only have 1 PT on the project)

telling me that the # of visits I use to treat my patients is over what the

national average but the number of units I billed per patient was less than

the national average. I am not really sure what they plan to do with this

information other than begin playing musical PT's clinics, by sending all

the patients to the clinic that has the least amount of visits and units

billed per patient. I have not been doing all the paperwork and when I

asked her what would happen if I didn't do it, she told me that Blue Shield

would be informed and they would decide what to do.

Just wondering if anyone else has had interaction with ACN and thier

thoughts on process. If anyone has any great insight I would be most

appreciative. Feel free to contact me directly at: barryhrma@...

Barry, PT

California

_________________________________________________________________

Stay in touch with old friends and meet new ones with Windows Live Spaces

http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?href=http://spa

ces.live.com/spacesapi.aspx?wx_action=create & wx_url=/friends.aspx & mkt=en-us

Please identify yourself, your discipline and your location in all messages

to PTManager.

Sick of working for someone else?

Tired of fighting against POPTS?

Ready to quit the corporate nonsense of large organizations?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join

APTA, AOTA or ASHA and participate now!

Please identify yourself, your discipline and your location in all messages

to PTManager.

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oh, we all know the way they control costs is by taking money from the

providers and limiting treatment for their own profits. I just wished everyone

would not sign up with them and leave them hanging in the wind and dry up on the

vine.

Bubba Klostermann OT, CVE, CEAS

Occupational Therapist

Certified Vocational Evaluator

Certified Ergonomic Assessment Specialist

Chief Executive Officer

WORK & REHAB

4546 South 14th

Abilene, Texas 79605

-phone

-fax

email:bubklo@...

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http://www.theacngroup.com/1-2-1.html

Here's the executive team. I would recommend e-mailing them with your

complaints ... again and again and again. I would also make patients aware

of the problems so they in turn can make their employers aware of the

problems so they in turn can choose insurance plans other than UnitedHealth

Group plans. This situation has already occurred on a small scale. Let's

promote it happening on a larger scale. If UnitedHealth can adversely

influence our patient's health care and our bottom line, it's only

reasonable that we stand as advocates for our patients and counter

UnitedHealth's actions. If we adversely affect their bottom line and make

them less competitive among insurers, hopefully, our patients will have

better choices become available as their potential insurers. Companies like

UnitedHealth do not serve anyone other than themselves (and especially the

upper echelons of their management). They are even stealing from their

shareholders as is evidenced by the recent scandal pertaining to backdating

stock options.

I would also contact your legislators and have them actively pursue

prosecution of McGuire, the recently resigned CEO of UnitedHealth

over the issue of backdating stock options as well as any other UnitedHealth

executives or officials who are similarly culpable. Just remember that part

of his 1.6 BILLION dollars in stock options came from your pocket.

Corruption starts at the top in these organizations and if the organization

is rotten, we should hasten its demise by actively rooting out the sources

of the problems, making the public and the government aware of them, and

promoting punitive action against them. And if ACN is part of that rot,

let's set the stage for their exit from the scene as well.

, PT, OCS

Marquette, MI

ACN from Blue Shield

>

> Has anyone had any interaction with this ACN group from Blue Shield and

> doing all of the paperwork that they are now saying they require from the

> therapist and the patient? Just what our patients want to do is fill out

> 3-4 more forms. I had an 45 minute phone conferance with a PT the other

> day

>

> from the ACN (from my understanding they only have 1 PT on the project)

> telling me that the # of visits I use to treat my patients is over what

> the

> national average but the number of units I billed per patient was less

> than

> the national average. I am not really sure what they plan to do with this

> information other than begin playing musical PT's clinics, by sending all

> the patients to the clinic that has the least amount of visits and units

> billed per patient. I have not been doing all the paperwork and when I

> asked her what would happen if I didn't do it, she told me that Blue

> Shield

> would be informed and they would decide what to do.

>

> Just wondering if anyone else has had interaction with ACN and thier

> thoughts on process. If anyone has any great insight I would be most

> appreciative. Feel free to contact me directly at: barryhrma@...

>

> Barry, PT

> California

>

> _________________________________________________________________

> Stay in touch with old friends and meet new ones with Windows Live Spaces

> http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?href=http://spa

> ces.live.com/spacesapi.aspx?wx_action=create & wx_url=/friends.aspx & mkt=en-us

>

>

>

>

> Please identify yourself, your discipline and your location in all

> messages

> to PTManager.

>

> Sick of working for someone else?

> Tired of fighting against POPTS?

> Ready to quit the corporate nonsense of large organizations?

> Visit www.InHomeRehab.com.

>

> PTManager encourages participation in your professional association. Join

> APTA, AOTA or ASHA and participate now!

>

> Please identify yourself, your discipline and your location in all

> messages

> to PTManager.

>

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Share on other sites

ACN was in CT about 5-6 years ago. At the 1st provider meeting, I began

citing policy of APTA, documentation guidelines that were different from

theirs, and other relevant information. Needless to say I was a thorn in

their side and they refused to acknowledge my questions after a couple of

'tough questions/comments'. It did however, give other PTs in the room the

courage to question their policies and procedures. Long story short, many

providers continued to cite problems with the procedures and voice c/o to

the powers that be (Insurance Commissioner, employer groups, etc) and ACN

lasted about 18 months.

This ACN group is just the type of activity that prevents us from becoming

the autonomous practitioners that we are striving to become. Autonomous

practice, as per the 2006 HOD, is defined as:

*Independent, self-determined professional judgment within one’s scope of

practice, consistent with the professions Codes and Standards and in the

patient’s/client’s best interest.

*Responsibility and acceptance of risk for all aspects of the physical

therapist patient/client management.

*Ability to refer to and collaborate with health care providers and others

to enhance the physical therapist patient/client management.

*Recognition of circumstances that necessitate a request for consultation

and initiation of such consultations when in the best interest of the

patient/client.

*Clinical decision making that is independent of external financial

considerations.

*Physical therapist governance and control of physical therapy practice in

all settings.

Note especially the independent, self-determined professional judgment and

clinical decision making independent of external financial considerations.

We need to be a strong voice and community to prevent the insurance

companies from putting us in the back seat. And yes, the change can start

with one person/clinic.

Peg

Peg Grey, PT, MA, ATC

Grey PT & Sports Medicine Center

Personalized Conditioning by Grey

101 Phoenix Avenue, Suite 2D

Enfield, CT 06082

Ph:

Fax:

E-mail: pegg@...

Re: ACN from Blue Shield

http://www.theacngroup.com/1-2-1.html

Here's the executive team. I would recommend e-mailing them with your

complaints ... again and again and again. I would also make patients aware

of the problems so they in turn can make their employers aware of the

problems so they in turn can choose insurance plans other than UnitedHealth

Group plans. This situation has already occurred on a small scale. Let's

promote it happening on a larger scale. If UnitedHealth can adversely

influence our patient's health care and our bottom line, it's only

reasonable that we stand as advocates for our patients and counter

UnitedHealth's actions. If we adversely affect their bottom line and make

them less competitive among insurers, hopefully, our patients will have

better choices become available as their potential insurers. Companies like

UnitedHealth do not serve anyone other than themselves (and especially the

upper echelons of their management). They are even stealing from their

shareholders as is evidenced by the recent scandal pertaining to backdating

stock options.

I would also contact your legislators and have them actively pursue

prosecution of McGuire, the recently resigned CEO of UnitedHealth

over the issue of backdating stock options as well as any other UnitedHealth

executives or officials who are similarly culpable. Just remember that part

of his 1.6 BILLION dollars in stock options came from your pocket.

Corruption starts at the top in these organizations and if the organization

is rotten, we should hasten its demise by actively rooting out the sources

of the problems, making the public and the government aware of them, and

promoting punitive action against them. And if ACN is part of that rot,

let's set the stage for their exit from the scene as well.

, PT, OCS

Marquette, MI

ACN from Blue Shield

>

> Has anyone had any interaction with this ACN group from Blue Shield and

> doing all of the paperwork that they are now saying they require from the

> therapist and the patient? Just what our patients want to do is fill out

> 3-4 more forms. I had an 45 minute phone conferance with a PT the other

> day

>

> from the ACN (from my understanding they only have 1 PT on the project)

> telling me that the # of visits I use to treat my patients is over what

> the

> national average but the number of units I billed per patient was less

> than

> the national average. I am not really sure what they plan to do with this

> information other than begin playing musical PT's clinics, by sending all

> the patients to the clinic that has the least amount of visits and units

> billed per patient. I have not been doing all the paperwork and when I

> asked her what would happen if I didn't do it, she told me that Blue

> Shield

> would be informed and they would decide what to do.

>

> Just wondering if anyone else has had interaction with ACN and thier

> thoughts on process. If anyone has any great insight I would be most

> appreciative. Feel free to contact me directly at: barryhrma@...

>

> Barry, PT

> California

>

> _________________________________________________________________

> Stay in touch with old friends and meet new ones with Windows Live Spaces

>

http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?href=http://spa

>

ces.live.com/spacesapi.aspx?wx_action=create & wx_url=/friends.aspx & mkt=en-us

>

>

>

>

> Please identify yourself, your discipline and your location in all

> messages

> to PTManager.

>

> Sick of working for someone else?

> Tired of fighting against POPTS?

> Ready to quit the corporate nonsense of large organizations?

> Visit www.InHomeRehab.com.

>

> PTManager encourages participation in your professional association. Join

> APTA, AOTA or ASHA and participate now!

>

> Please identify yourself, your discipline and your location in all

> messages

> to PTManager.

>

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You Go, Peg!

I wondered about the part that said they had their own guidelines. Since

you're in lovely Connecticut, you know that insurance companies are

*financial* institutions, rather than benevolent patient-centered clinical

organizations. The main concept of an insuror is to accept premiums and

then reduce their " medical claims " as low as possible, in order to maximize

the leftovers to be shared by the owners.

One way to do that is to erect " barriers " to access (complicated provider

enrollment, closed provider panels, geographic limitations, etc.), claims

(elaborate forms, medical review, price-fixing, denials) in the name of

" Quality " .

I think that you're right to assert that our professional association is the

more appropriate group to oversee our clinical model. It is certainly more

appropriate than a Chiropractic group. Our APTA components have committees

which oversee our definition of PT practice. Actually, I think that our

Guide to Practice, which was reportedly developed to explain PT practice to

insurors (who think that all we do is conspire to defraud them! - Seriously)

is the appropriate clinical practice model.

Thanks again for your post.

Regards,

Dick

W. Hillyer, PT, MBA, MSM

Hillyer Consulting

700 El Dorado Pkwy West

Cape Coral, FL 33914

Home

Fax

Mobile

Re: ACN from Blue Shield

http://www.theacngroup.com/1-2-1.html

Here's the executive team. I would recommend e-mailing them with your

complaints ... again and again and again. I would also make patients aware

of the problems so they in turn can make their employers aware of the

problems so they in turn can choose insurance plans other than UnitedHealth

Group plans. This situation has already occurred on a small scale. Let's

promote it happening on a larger scale. If UnitedHealth can adversely

influence our patient's health care and our bottom line, it's only

reasonable that we stand as advocates for our patients and counter

UnitedHealth's actions. If we adversely affect their bottom line and make

them less competitive among insurers, hopefully, our patients will have

better choices become available as their potential insurers. Companies like

UnitedHealth do not serve anyone other than themselves (and especially the

upper echelons of their management). They are even stealing from their

shareholders as is evidenced by the recent scandal pertaining to backdating

stock options.

I would also contact your legislators and have them actively pursue

prosecution of McGuire, the recently resigned CEO of UnitedHealth

over the issue of backdating stock options as well as any other UnitedHealth

executives or officials who are similarly culpable. Just remember that part

of his 1.6 BILLION dollars in stock options came from your pocket.

Corruption starts at the top in these organizations and if the organization

is rotten, we should hasten its demise by actively rooting out the sources

of the problems, making the public and the government aware of them, and

promoting punitive action against them. And if ACN is part of that rot,

let's set the stage for their exit from the scene as well.

, PT, OCS

Marquette, MI

ACN from Blue Shield

>

> Has anyone had any interaction with this ACN group from Blue Shield

> and doing all of the paperwork that they are now saying they require

> from the therapist and the patient? Just what our patients want to do

> is fill out

> 3-4 more forms. I had an 45 minute phone conferance with a PT the

> other day

>

> from the ACN (from my understanding they only have 1 PT on the

> project) telling me that the # of visits I use to treat my patients is

> over what the national average but the number of units I billed per

> patient was less than the national average. I am not really sure what

> they plan to do with this information other than begin playing musical

> PT's clinics, by sending all the patients to the clinic that has the

> least amount of visits and units billed per patient. I have not been

> doing all the paperwork and when I asked her what would happen if I

> didn't do it, she told me that Blue Shield would be informed and they

> would decide what to do.

>

> Just wondering if anyone else has had interaction with ACN and thier

> thoughts on process. If anyone has any great insight I would be most

> appreciative. Feel free to contact me directly at:

> barryhrma@...

>

> Barry, PT

> California

>

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>

>

>

> Please identify yourself, your discipline and your location in all

> messages to PTManager.

>

> Sick of working for someone else?

> Tired of fighting against POPTS?

> Ready to quit the corporate nonsense of large organizations?

> Visit www.InHomeRehab.com.

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Please identify yourself, your discipline and your location in all

> messages to PTManager.

>

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