www.njchiropractors.com I 13 or SEHBP. Patients can review the differences between these plans and the Aetna Medicare Advantage plans at the NJ Division of Pension and Benefits website: https://www.state.nj.us/ treasury/pensions/. You would click on Health Benefits then > Information for Retirees > choose State Health Benefits Program or School Employee Health Benefits Program > Review Your Plan Choices > Summary of Benefits and Coverage for Plan Year 2019. There are significant differences between the plans these retirees had and the plans they have been moved to this year. When these plans were first announced and their documents posted on the state website, it was stated that chiropractic care would be limited to spinal manipulation only. Aetna also advised that the plans would be subject to their new pre-authorization program. At that point, the ANJC launched a public education campaign to alert these retirees of the changes that were coming and what else was available as options. The campaign consisted of radio and social media ads, fliers and billboards. These efforts informed well over 14,000 people of these changes, many of whom voiced their concerns to the state and their unions. On Nov. 16, Aetna shared with ANJC revised chiropractic benefits under their SHBP/ SEHBP Medicare Advantage plans. These revised benefits included up to 30 visits without pre-authorization and “other services within the scope of the chiropractors license . . .” The ANJC sent a list of follow-up questions to Aetna to clarify a number of issues regarding how claims will be handled. Some questions were answered such as: • Out of network providers will be reimbursed at Medicare rates for all allowed services with a $10 copay. • Pre-authorization will still apply to other physical medicine services such as physical therapy • Covered services that do not have a Medicare fee schedule amount, such as acupuncture, will be reimbursed at Aetna fee schedule rates for out of network providers. One very important question that had not been answered at the time of printing is what specific codes under the chiropractic scope of practice will be covered and if there are any exclusions. We will alert ANJC membership once those codes are confirmed. In Aetna’s original documentation of these changes, it was noted that should a retiree wish to choose another plan, they had to do so by Dec. 1, 2018, to avoid being enrolled in the Aetna Medicare Advantage plan for the year. Normally, once enrolled in a plan the retiree would have to wait a year before being able to change their selection. However, retirees who were enrolled in the Aetna Medicare Advantage plan have been receiving letters that have advised they can change back to original Medicare up until March 31, 2019, should they choose to. So, there may still be time for any patients who have been enrolled in Aetna Medicare Advantage to switch back if they wish. If you have patients who would like to do this, you can direct them to the NJ Pension and Benefits website: https:// www.state.nj.us/treasury/pensions/ or advise them to call 609-292-7524. Data iSight: For several months, members have been seeing significant reductions on their out-of-network claims from a third-party repricing company called Data iSight. This company is lowering the allowed amounts on claims for out-of-network providers and creating the impression that the provider cannot balance bill the patient for the difference. This is being done despite there being no contract between the provider and the carrier nor Data iSight. It has been reported that patients are receiving EOBs showing different balances due and allowed amounts than what the provider is receiving. This has occurred most often on CIGNA plans. We have, however, begun to see these incidents occur on other plans as well. Data iSight reductions have been identified on plans under United Health- care, Meritain (an Aetna subsidiary) and self-funded organizational plans such as the University of Pittsburgh Medical Center. The ANJC has sent cease and desist letters to CIGNA and Data iSight directing them to end this pattern of unlawful reductions in reimbursement. No response was received at the time of printing, and the ANJC was in the process of filing a formal complaint to the NJ Department of Banking and Insurance. 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