Several DC’s in Maryland recently received notification from CareFirst BlueCross/BlueShield denying their claims for chiropractic care given to children under the age of twelve. According to the insurance company letter, “The CareFirst Medical Policy Committee considers spinal manipulation services to treat children twelve years of age and younger, for any condition, to be experimental/investigational.”
The company’s policy also states, “Spinal manipulation services for treating non-musculoskeletal disorders such as asthma, hypertension, gastrointestinal disorders, infections, fatigue, or mental and nervous conditions are considered experimental/investigational....”
One could argue that these policies should not apply to chiropractic, since we provide chiropractic adjustments, not spinal manipulation, and we correct vertebral subluxation rather than “treat” diseases. But, the fact is, these policies are being applied to chiropractors since we have not yet succeeded in proving to the insurance industry (and the rest of the world) that we are a separate and distinct profession with unique objectives and methods.
Even worse, we have little hard scientific evidence to support our assertion that chiropractic is beneficial for children—or for adults. With the exception of research on chiropractic for low back pain in adults, where is the documentation to shove under the noses of the insurance company execs that will prove to them that chiropractic is efficacious for children under twelve and that subluxation correction can have a direct, positive impact on non-musculoskeletal disorders?
One landmark study that laid the groundwork for further exploration is the research conducted by Bob Blanks, PhD, published in Journal of Vertebral Subluxation Research. In this study of 2,818 chiropractic patients, initial findings were that the chiropractic care provided (in this case, by Network practitioners) “was associated with significant improvement in all indicators of health evaluated.” Based on the patients’ own evaluations of their health and wellness, they showed nearly a ten percent improvement in four wellness components: physical state, mental/emotional state, stress evaluation and life enjoyment.
Furthermore, the results were seen after only one to three months under care, and, according to the researchers, “appear to show continuing clinical improvements in the duration of care intervals studied, with no indication of a maximum clinical benefit.”
The bottom line interpretation of the study is that people’s general health and wellness improve with chiropractic, and continue to improve as long as they continue that care.
But, that original study is merely a starting point for the research we need to provide to get chiropractic out of the “experimental/investigational” category. We need to compare the health of patients “before and after” receiving chiropractic, using both objective clinical tests and subjective self-evaluation tools. These patients must represent the widest possible sampling of the population, including children as well as adults and asymptomatic patients and those with specific health issues.
The doctors whose claims were rejected by BlueCross/BlueShield know firsthand the direct impact that research can have on their practice. It seems reasonable to assume that other doctors around the country will be receiving similar letters soon as other insurance companies realize that they can reduce claims costs significantly by following CareFirst’s example.
What will happen to your practice if insurance coverage is denied for ALL children under twelve or ALL patients who are coming to you for non-musculoskeletal problems? You could, of course, switch to a cash-only practice. But, if history has taught us anything, it’s that any successful anti-chiropractic campaign usually spreads far beyond its original scope. It’s not hard to imagine a time when the medical profession will attempt to make it illegal for chiropractors to provide that kind of “experimental/investigational” care, at least not without medical supervision. Will we have to display a “warning” sign in our office, like a cigarette pack with its “this product may be hazardous to your health” label?
Dr. Jackson is chief executive officer of Research and Clinical Science (RCS), a private sector research program exploring issues of subluxation correction and chiropractic care as they relate to health and wellness. Previously, he served as president of the Chiropractic Leadership Alliance and Creating Wellness Alliance and was owner/operator of several private practice offices in California and Idaho that specialized in high volume, family wellness based care. To learn more or to sign up as an RCS Authorized Research Site, call 800-909-1354, 480-303-1694, or visit the Doctors-Only section of the RCS website at www.rcsprogram.com. Log in with username rcsdoctor and password rcsdoctor.