George Fighting New Computer Program for Therapy Eligibility

State Rep. Camille “Bud” George

HARRISBURG – State Rep. Camille “Bud” George, D-74 of Clearfield County, is seeking co-sponsors for a resolution urging Highmark Inc. to rescind its use of the Physical Medicine Management Program to determine whether a patient is eligible to receive treatment from a physical or occupational therapist or chiropractor.

“In September, Highmark began requiring preauthorization for these services after the eighth visit in a calendar year,” George said. “After the eighth visit, Highmark now uses a computer algorithm, the Physical Medicine Management Program, to determine eligibility.”

George said he feels this unfairly hurts patients who have a legitimate need to see a physical or occupational therapist or chiropractor. Likewise, the policy hurts medical professionals treating individuals suffering from chronic pain.

“If you have a back injury or another chronic physical ailment, often the symptoms may last for months or years and require continuing treatment,” George said. “Let’s use a little common sense: Who is better to make that determination, a physician or a computer program?”

George said that he believes that the prompt relief afforded by physical or occupational therapy and chiropractic services is invaluable and continued access to these services will save patients countless dollars in unnecessary medical bills. Furthermore, he said Highmark should allow doctors and other medical professionals to determine the best treatment for patients, not a computer program.

“I hope that Highmark will reconsider its new policy after looking at the potential repercussions,” George said. “If a computer model makes an error and a patient suffers more because of it then it will only cost the insurer more money and the patient more grief.”

George is seeking House members’ support and intends to introduce the resolution soon. He said that with enough support, it can be passed before the end-of-term deadline.

“I’ve received support from members on both sides of the aisle,” George said. “Let’s make one more push and get it through as soon as possible.”

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