As many of you loyal blog readers over the years have come to realize, I have an unusual pastime of watching the activities of insurance payers and reporting on their shenanigans to the chiropractic community. In performing some of my recent watchdog rounds, I stumbled upon a video blurb (3 minutes) from the CEO of Aetna who was seriously slopping on some self-praise for Aetna’s progressive thinking alternative medicine approach.
In the video clip (see link), you’ll hear some interesting ideas that may lead you to believe that Aetna is on our side in embracing the holistic approach avowed by many chiropractors. You will also learn the CEO’s personal success story with “alternative medicine,” hear his snarky comment made to his MD and some positive attention put towards yoga, mindfulness training (meditation) and craniosacral therapy.
This may all sound wonderful to the average uneducated viewer, except for the fact that based on Aetna’s history, I had some strong suspicions on whether Aetna pays for any of the treatments boasted on by their CEO. Some quick research later confirms the fact that Aetna not only declares ALL of these things previously mentioned as investigational, but they have been meticulously adding to their experimental list over the years.
Aetna’s Partial List of Investigational Techniques
In case you believe my title poses a bit of an exaggeration for this payer’s “danger” factor, here are just a few examples of chiropractic techniques and therapies that Aetna has deemed investigation (translation = non-reimbursable):
- Active Release Technique
- Applied Kinesiology
- Chiropractic BioPhysics
- CranioSacral Therapy
Thought maybe I should stop at the C’s as the list goes on and on. You can read the full list of investigational techniques on the chiropractic policies page and on their general (and gargantuan list) of investigational Complementary & Alternative procedures.
And, if you are like most chiropractors, you will quickly realize that many of those techniques are being utilized in your office daily…suddenly making much of what you do non-reimbursable.
Removing the Danger & the Doublespeak
If it sounds like I’m being a little harsh with Aetna here in labeling them a danger, put this in perspective. To a degree, all payers have their list of investigational procedures. Supposedly, this list is based on research, although a quick view of the chiropractic list would certainly question this. Herein lies the double danger, in my opinion:
If your CEO goes on record promoting your fabulously progressive policies and praising it’s own company for internally implementing policies that lead to their own employees better health BUT….simultaneously deny that same care to the patient population it takes premium dollars from – what exactly do you have? It appears that you have a payer willing to boldfacedly proclaim one thing and backstab you behind-the-scenes…for the purpose of profits.
Now some of you may argue that all insurance companies operate in the same manner and to a degree, you may have a point. But when one payer basically pulls a Tom Cruise and bounches up and down on his sofa platform proclaiming his love for alternative medicine and then, goes back to the office and gives the nod to denying all these services as investigational, this needs to be called out.
What to Do Next
- Check the Policies Pages. You need to know when Aetna (and other payers) decide to arbitrarily declare your favorite technique investigational.
- Make Noise – Tell your state or national association about this nonsense. Support chiropractic research that will promote your position. Comment on the youtube video with Aetna’s chair. Send word to Aetna to put their money where their mouth is. Just do something.
- Prepare and Protect – emotions aside, you also have two big issues here inside your practice. First, if you don’t know this stuff, you are apt to lose a lot of money by not protecting your practice. Second, you must prepare your practice to navigate these constant changes – along with other chiropractic billing and coding changes that have or will be happening as well. If not, this lack of knowledge will cause you to needlessly suffer audits, denials and unintentionally giving away services you should have been paid for.
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