If you are a United Healthcare® chiropractor (regardless of whether you are in or out of network), beware of their new limitations of what you cannot treat (at least if you want to be paid). UHC’s June 2018 policy update on spinal manipulation provides a very significant and admittedly strange entry into their widening “experimental and investigational services” category.
Of course, most United Healthcare chiropractors (and for that matter, DC’s providing services for any insurance company) understand that conditions or techniques labeled as “investigational” or “experimental” are basically the equivalent of non-covered services and the kiss of death for any chances of reimbursement.
Worse, UHC’s June policy update not only throws out a huge chunk of what chiropractors can adjust and be paid for (and if you are an in-network United Healthcare® chiropractor, you will be required to write-off these unpaid services) the new policy also throws some chiropractic techniques under the bus as well – potentially making ALL the work you do as a United Healthcare chiropractor to be declared as “investigational.”
While I’m not sure there is any good news or silver lining in this dark cloud, here are the details:
The June 2018 Policy Update
Every payer periodically updates their payment and medical policies and typically the changes are pretty minor. Nevertheless, my geeky self continues to subscribe and slog through these updates because occasionally an item like this one from UHC comes around that has potential to affect our chiropractic profession on a large scale. The UCH June 2018 news bulletin noted that there were updates to the Manipulative Therapy section of their Medical Policies and begins with a harmless sounding reference to the removal of “Gait Analysis” from the policy language. But for those who persisted to read further, what lurks beneath is where the real danger lies. Here’s why:
United Healthcare® now has listed Manipulative Therapy as “unproven and/or not medically necessary for treating Non-musculoskeletal disorders, including but not limited to:
- Lungs (e.g., asthma)
- Internal organs (e.g., intestinal)
- Neurological (e.g., headaches)
- Ear, nose, and throat (e.g., otitis media)
- Temporomandibular joint (TMJ) disorder
BIG Problem With The UHC List
For those of you who have attended my chiropractic billing & business seminars in the past, you will not be surprised to hear that United Healthcare® (or pretty much any payer) will not reimburse you as a chiropractor for asthma, ENT problems such as otitis media or intestinal work. Those who are bit more savvy in this area will not be shocked to see that TMJ or scoliosis are among the conditions not covered with respect to your chiropractic adjustments.
The surprise here lands in the middle of the list bearing the label “Neurological” conditions, and perhaps most significantly, is the direct reference to “headaches” as a condition for which manipulative therapy is considered unproven — and of course, unpayable.
Equally frustrating and almost laughable is UHC’s justification for their policy decision in which they make reference to a whopping 2 studies on spinal manipulation and headaches. Interestingly enough, both studies they used actually showed benefits of chiropractic adjustment on headaches AND a quick search of the medical literature would surely reveal more studies that show that as well. As a side note, I’d love to see someone like Dan Murphy DC or perhaps The Evidence Based Chiropractor send a research-bomb of dozens of studies disproving UHC’s insane policy decision.
But Wait, There’s More — And It’s WORSE!
For any United Healthcare® chiropractors, the bad news gets quickly worse when you dive deeper into the nonsense of UHC’s policy decision because at the very bottom of their document UHC makes reference to Medicare policies on chiropractic — which cover spinal manipulation for various neurological conditions, including headaches! Yes, you read that right. In the same stupid policy which effectively bans chiropractors from getting paid to help folks with their headaches or other neurological conditions, they reference a policy from Medicare that actually states that chiropractors would be reimbursed for these very same conditions. In fact, every Medicare carrier in the country has Local Coverage Determinations which cover headache diagnoses as one of the accepted conditions for chiropractic care!
Even worse, UHC’s policy statement is so vague that it does not specify what exactly a Neurological condition is. As United Healthcare® chiropractors, I’m sure that you would have confidence on the effectiveness of your chiropractic adjustments for a patient who presented with a back pain related to a disc problem. In the past, you’d probably be confident that UHC would reimburse your chiropractic care for this back pain. Now, you may have to fear any neurological involvement as potentially making your treatment not payable.
I’m sure that you can easily see the danger and the ridiculousness (and perhaps the intentionality) of UHC not providing any list of “experimental” ICD-10 codes along with this policy so that a United Healthcare® chiropractor (or even Osteopaths, since the policy affects them too) could reasonably determine what UHC deems as “neurological” and experimental.
The Technique Trash
If my opinions are not clear to you by now, this policy needs to hit the trash bin quickly and be revised to make some sense. But if you practice SOT, NUCCA or any of the “non-standard” techniques (as labeled by UHC), you can kiss ALL reimbursements for your care goodbye. Yes, they have labeled these techniques investigational and not payable too — whether or not you have a patient with a neurological condition or a headache (yours or your patients).
WHAT TO DO NEXT
If you are a United Healthcare chiropractor, first and foremost you need to be aware that your payments are in jeopardy thanks to this new policy. And I’d strongly suggest you make some noise and/or get some clarification from UHC as to exactly what in the world this policy change may mean.
Unfortunately, UHC also has a history of an adversarial relationship with chiropractors, so my next suggestion would be to not limit your comments or complaints to only the payer or your patients. But this is a great reason to support your state and national chiropractic associations so that the “big guns” can fire back on this issue and get things better explained or changed.
Finally, these type of policy changes are not atypical on a national or local level and are the frequent topic of what I teach in my chiropractic seminars. Frankly, to be successful in today’s chiropractic marketplace, you must be aware of these insurance updates so that you can get paid, so that you can protect your practice and so that you can learn how to thrive in spite of all the insurance changes around you. Check out our upcoming Smarter Chiropractic seminars where we are going to be teaching you Best Practices for Profitable & Compliant Chiropractic, Massage & Rehab Billing, Coding, Documentation & Business Strategies So You Can Work SMARTER in 2018, Not Harder!