The American Chiropractic Association (ACA) just sent a polite, but firm, letter that objects to the new United Healthcare Chiropractic policy that is presently creating quite a stink in our profession. The letter was co-signed by State Association Presidents as well as other prominent political advocates for the chiropractic profession such as Jay Greenstein, DC of Clinical Compass, Don Cross, DC (President of the Congress of Chiropractic State Associations) and Quentin Brisco, DC (President of the American Black Chiropractic Association) — all of whom uniformly voiced their opposition to the United Healthcare Chiropractic policy that was released for update on June 1, 2018. (You can read the entire ACA letter here)
In a nutshell, here are the big problems with the rotten fish that UHC has delivered to chiropractors in the form of this policy change:
Quick Facts About the New United Healthcare Chiropractic policy
- The latest United Healthcare Chiropractic policy lists manipulative therapy as “unproven” or “investigational” for treating neurological problems and the specific example given is “Headaches”
- UHC does not pay for investigational procedures
- The UHC policy refers specifically to the chiropractic manipulative codes 98940,98941, 98942 and 98943
If you haven’t heard about the UCH policy, you can read my previous blog post in full here: United Healthcare Chiropractor? Here’s What You Can No Longer Treat.
What’s Wrong With This Policy (For Starters)
Manipulative Therapy Policy Targets Chiropractors – don’t be fooled by the fact that this is labeled as a Manipulative Therapy policy which, in theory, could indicate that it also affects Doctors of Osteopathic Medicine (DO) and/or Physical Therapists who use manipulative techniques. A quick dive into the actual UHC Manipulative Therapy policy will reveal that the only CPT codes affected by this policy are the ones used by chiropractors! Specifically — 98940,98941,98942 and 98943. In other words, DO’s and PT’s aren’t bound by the same policy – so long as they stay away from using these CPT codes.
Vague Policy Language Can Mean MORE Bad News
Obviously, we chiropractors have an issue with UHC claiming that chiropractic adjustments for headaches are unproven. But this policy can potentially open a bigger can of worms than that. The United Healthcare Chiropractic policy states that manipulative therapy is investigational for “Neurological” conditions — what exactly does that mean? Obviously, headaches are out — that’s listed in the example. What about neuropathies? What about nerve root disorders? Nerve injuries? Disc injuries where the patient is exhibiting neurological signs? In other words, this policy can either specifically exclude headaches or it can broadly ban chiropractic treatment on dozens of different conditions and effectively give UHC the right to deny services rendered for those conditions. But without a defined list of “prohibited” ICD-10 codes that are associated with this policy, we have no way of knowing what in the world UHC means.
Material Change to Contract Notice?
Payer are typically required to give advanced notice to a “material” change to a provider’s contract either by state law or through the contractual agreement the provider had with the payer itself. Yet, the latest United Healthcare Chiropractic Policy update does not seem to adhere to this at all. UHC may argue that this was not a significant change, but seeing that the World Health Organization estimates that 1 in 20 adults suffer headaches each day and research indicates that tension headaches are the 2nd most common illness in the world (followed by migraine at #3), a change to a payer policy that effectively forbids a doctor to treat such a prevalent condition absolutely is a significant change to their contract.
Support your state and national associations who are fighting this! The challenge here is not only with UHC. If other payers see that UHC gets away with this, they can change their policies accordingly and effectively eliminate a chunk of your patient reimbursements in the process.
Enlist and/or educate your patients in the battle. Patients presume that their insurance covers most things. They rarely understand an exclusion like this and it probably wouldn’t even be on their radar that the United Healthcare Chiropractic policy would cover some conditions treated by a chiropractor, but not others. Obviously, the “experimental” label regarding the treatment of headaches would and should concern them! Be sure to educate them BEFORE you treat. That way, they are aware that you are (for now) providing a non-covered service. With patients on your side, they can become advocates for you in getting this policy with their insurance withdrawn.
Start working smarter! We are way past the point in chiropractic where being a contracted provider with every insurance is a good move. And when you see restrictive policies like this come your way, it only drives home the point even further. Take time to evaluate your payer contracts, reimbursement policies, the number of patients that are affected — and be prepared to take action. Doing things the “same old way” you’ve always done them is not only the definition of insanity but a surefire way to work way harder for the dollars that you earn. I’ve been preaching the message of working smarter in our chiropractic practices for long enough that I know many of you blog subscribers have heard this before, but this illustrates the point as well as any (and is the reason why we continue to teach deep dive strategies to my coaching clients and at my seminars). So, it’s time to get our heads out of the sand, draw a line in the sand and get to work making a brighter future for your patients and for your business.