As of January 2014 Blue Cross and Blue Shield of Illinois in the Chicago area is planning to contract Orthonet to case manage the utilization of Physical Therapy for many of their PPO clients. Although there are many utilization companies out there, Orthonet has a past history of deeming patients ready for discharge when they feel they are 80% better, not 100%. What does that mean for the thousands of people recovering from surgery, an injury, a motor vehicle accident, or any painful diagnosis. It means that they will deny your care before you are fully healed or able to fully function the way YOU want to. Orthonet has denied the allegation of denying patients when they are only 80%, but in a story that broke in 2005 when they denied a toddler Physical Therapy to help her regain full ROM of her elbow due to a congenital condition, their own internal documents were revealed and they could not dispute the allegation. (Google is 80% the New 100% by Fred Mogul to read the article).
Here we go again with insurance companies denying care for the treatments that we deserve to have as a paying customers. When are the constant denials going to end? When are we going to stand up to insurance companies and say "enough is enough!"? Why do we continue to accept the limitations in treatment while these insurance companies continue to make billions of dollars?
Help us stop this from happening in Chicago. Help the millions of BCBS clients retain their Physical Therapy benefits that allow them to get back to 100%. Let Blue Cross and Blue Shield know that 80% is not acceptable.