Hawaii chiropractors are protesting new treatment review policies implemented by HMSA, the state’s largest health insurer, which providers claim are causing significant financial losses and threatening the viability of local practices. According to reports from Hawaii News Now, some clinics are seeing denied claims totaling tens of thousands of dollars per month, leading to concerns over a worsening healthcare provider shortage in the islands.
HMSA Treatment Reviews and the $100,000 Monthly Loss
The conflict centers on new physical medicine program updates that HMSA introduced in April. While the insurer states these changes ensure care is “appropriate, effective, and aligned with evidence-based clinical guidelines,” practitioners report a volatile payment environment.
Dean Shivvers, president of the Hawaii State Chiropractic Association and owner of Turning Point Chiropractic, reports that denied charges have reached $100,000 a month at his Kaimuki practice alone. Turning Point is one of the state’s largest clinics, employing 17 practitioners.
Joseph Leonardi, D.C., a chiropractor at Turning Point, notes a lack of consistency in how claims are handled. He states that HMSA may pay for several initial visits before abruptly stopping payment for follow-up exams. This unpredictability leaves patients questioning if they are covered or if they are suddenly responsible for the full cost of care.
Did you know? Turning Point Chiropractic’s experience highlights a broader trend where larger practices absorb massive losses, but smaller offices may face an even more immediate risk of closure due to the same policy shifts.
Provider Shortages and Legislative Concerns
The financial pressure on chiropractors has drawn the attention of state lawmakers. State Rep. Scot Matayoshi, chair of the House Consumer Protection Committee, warned that Hawaii is already facing a provider shortage.
According to Matayoshi, HMSA holds significant influence over the healthcare system. He cautioned that if these policy changes “rock the boat too much,” it could lead to an even greater doctor shortage than they already have.
They pointed to a prior instance where the governor intervened to stop a separate HMSA plan regarding physician payment structures, expressing hope for similar intervention in the chiropractic sector.
Comparing Insurer Goals vs. Provider Reality
There is a sharp contrast between how HMSA and the practitioners describe the new assessment process:
| HMSA Position | Provider Experience |
|---|---|
| Aims for “consistent way to review” care and better health outcomes. | Reports of “consistency issues” and sudden payment stops. |
| Focus on evidence-based clinical guidelines. | Increased paperwork and delays in coverage determinations. |
Frequently Asked Questions
Why are Hawaii chiropractors protesting HMSA?
Practitioners are protesting new treatment review policies that they claim lead to frequent claim denials and significant monthly revenue losses.
How much money are some practices losing?
According to Dean Shivvers of Turning Point Chiropractic, his practice has seen denied charges totaling $100,000 per month.
What is HMSA’s justification for the changes?
HMSA states the updates are intended to ensure members receive care that is effective, appropriate, and aligned with evidence-based clinical guidelines.
Could this affect patient access to care?
Yes. State Rep. Scot Matayoshi has expressed concern that these policies could lead to an even greater doctor shortage than they already have.
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