The County Commission’s decision last December to place a cap on the acupuncture benefit in the health-insurance plan offered to county employees saved taxpayers nearly $1 million in the 2017 fiscal year that ended on Sept. 30.
County Administrator Jason Brown said he expects the acupuncture costs to decrease again in 2018.
“We didn’t implement the cap until Feb. 1, so the fiscal 2017 numbers included the four months before we limited the acupuncture benefit,” Brown said.
“With the cap in effect for the entire year, the 2018 numbers should be significantly lower.”
According to Suzanne Boyll, the county’s human resources director, the county’s health-insurance plan paid out more than $1.1 million to one local acupuncture practice – Jill Jaynes’ Absolute Integrated Medicine – from October 2015 through September 2016.
That amount covered 34,340 visits for 253 plan members who sought treatment at Absolute.
Those numbers plummeted in the fiscal year that ran from October 2016 through September 2017, when only 126 members submitted claims for 3,863 visits and less than $180,000 was paid to Jaynes’ practice.
“That’s a reduction of more than 84 percent,” Boyll said, “just to one provider.”
It was Boyll who alerted commissioners 12 months ago that the county, which is self-insured, had paid out more than $1.1 million in claims to Jaynes’ practice in fiscal 2016 – more than to any other non-hospital, health-care provider during that same period.
To put that number in perspective: The Indian River Medical Center billed the county only $1.6 million for treating county employees and their dependents during that same period; and the Sebastian River Medical Center was paid only $560,000.
In fact, Boyll said, the county health plan’s payouts to the out-of-network provider had quadrupled over a four-year period. She attributed the surge in visits and skyrocketing payouts to Jaynes’ policy of not requiring a co-insurance payment, essentially allowing patients to seek free, unlimited treatment.
After a public hearing, the commissioners voted to place a cap on the county’s acupuncture coverage, limiting plan members to 26 visits per year and a maximum annual payout of $1,500 per patient per year.
“Based on the numbers, we can infer only that the plan change had a positive impact,” Boyll said, citing the steep reductions in members filing claims for acupuncture services provided by Jaynes’ practice and payouts to Absolute. “We’re looking at nearly a $950,000 difference from the previous 12-month period.”
Boyll said the county has not received many complaints from employees about the cap.
“They still can go for treatment; they’re just limited to 26 visits and $1,500 per year,” Brown said, adding, “The cap has had the desired effect. Our health plan did far better last year than it did the year before.”
Jaynes has defended her billing practices and disputed the county’s numbers, contending that they’re misleading and have been twisted to make her the scapegoat for the county’s failure to properly regulate and monitor its health plan, which, until February, allowed patients unlimited access to acupuncture treatments.
In response to the cap, Jaynes said she stopped accepting the county’s insurance on Jan. 1. Actually, though, she only discontinued filing the claims for her patients.
“She’s still taking it,” Boyll said, citing the nearly $180,000 the county paid to Absolute in fiscal 2017.
Asked about the dramatic drop-off in payouts from the county plan in fiscal 2017, Jaynes said her practice is still thriving.
“County employees still received treatments at our clinic [in the past year]. The difference now is they pay for treatments out of pocket,” Jaynes wrote in an email to Vero Beach 32963 last week.
Many of those patients, though, are now choosing treatment in a group setting in Absolute’s less-costly community room, rather than a more-expensive private room.
As for the county blaming her for the soaring costs that prompted the commissioners to act, Jaynes wrote: “We provided a service year after year after year, and the insurance company paid for it until somebody at the county decided it was costing too much and wanted to put a cap on it.”
Brown and Boyll said the problem was that Absolute billed the insurer – Florida Blue serves as the third-party administrator off the county’s health plan – but did not require patients to cover any of the costs of the treatments.
In other words: There was no co-pay.
That meant patients could seek treatment, free of charge, as much as they needed or wanted. The county was picking up the check.
“Some people were going 200 times a year,” Brown said.
Jaynes, whose practice offers five acupuncturists and 11 treatments rooms in the Bridgewater Building on Indian River Boulevard, said earlier this year that she often waived the co-pay for patients experiencing financial hardship.
Brown said he asked both Florida Blue and the Florida Office of Insurance Regulation to investigate Jaynes’ billing and the claims filed by her patients. The OIR has since forwarded the case to the Florida Department of Financial Services.
John Moore, spokesman for the DFS’ Division of Investigation and Forensic Services, confirmed Monday that his agency had received two inquiries relating to Jaynes’ practice.
“Currently, the matter is under review,” he said, “but I cannot provide any specifics at this time.”
