While You Were Treating: Getting Paid for the Treatment of Headaches? What You NEED to Know.
In May 2018, unbeknownst to most of the chiropractic profession, UnitedHealthcare announced a policy change in their monthly update that would have cost the profession millions of dollars per month in lost reimbursements. The policy updated its widening “experimental and investigational services” category, which are non-covered services. The updated policy listed Manipulative Therapy as “unproven and/or not medically necessary” for the treatment of some conditions that are investigational at best. What it also listed, that would have a significant impact on the profession, was “Neurological (e.g., headaches).” The direct reference by UnitedHealthcare to headaches would have made manipulative therapy unpayable or in the case of chiropractors who are in-network, uncollectible as these charges would be written-off.
In the U.S., more than 38 million people suffer from migraines. Some migraine studies estimate that 13 percent of adults in the U.S. population have migraines, and 2-3 million migraine sufferers are chronic (Miles, 2010). “Research shows that spinal manipulation, one of the primary treatments provided by doctors of chiropractic, may be an effective treatment option for tension headaches and headaches that originate in the neck. A 2014 report in the Journal of Manipulative and Physiological Therapeutics (JMPT) found that interventions commonly used in chiropractic care, improved outcomes for the treatment of acute and chronic neck pain and an increased benefit was shown in several instances where a multimodal approach to neck pain had been used. A 2011 JMPT study found that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches.” (American Chiropractic Association, 2016)
Today, we as healthcare consumers, just like our patients, are feeling the “squeeze” as insurance companies continue to reduce what is covered by insurance and what becomes the financial responsibility of the patient. It should come as no surprise that UnitedHealthcare announced in January 2018 that their revenue for 2017 surpassed the $200 billion mark for the first time. In January 2019, UnitedHealthcare reported that its 2018 revenue reached $226 billion, a 12% increase over the previous year (Business Wire, 2019). As a business owner, I firmly believe in running a profitable business. However, I strive to make decisions that benefit the patients and providers I serve, my employees, and finally myself and my business. I ask myself if we’re doing the right things, for the right reasons, in the right ways. Every company has the right to be profitable, even into the billions, but not at the expense of denying care to patients who benefit from care supported by valid literature.
Within days of this announcement, Dr. Jay Greenstein, Chairman of the Clinical Compass (formerly Council on Chiropractic Guidelines & Practice Parameters, CCGPP), received an email asking him to look into it. After verifying that the information was accurate, he mobilized the Chiropractic Congress (formerly Congress of Chiropractic State Association, COCSA), the American Chiropractic Association (ACA), the American Black Chiropractic Association (ABCA), and many others to fight back. What would have taken years and possibly legislative action in the past was resolved in under a month. In a letter to UnitedHealthcare’s Dan Schumacher, American Chiropractic Association (ACA) President N. Ray Tuck Jr. said he was “astounded” to find the insurer would no longer cover chiropractic spinal manipulative therapy (SMT) for patients with migraines and severe headaches. The letter addressed the decision by UnitedHealthcare to label the treatment “unproven and/or not medically necessary,” and included eight studies over eight years that proved that is not the case. On August 13, 2018, the ACA announced that they had received confirmation from UnitedHealthcare that it had restored its policy in support of coverage for non-drug manipulative therapy for headache treatment. The change was posted online as a revised policy document, dated August 1, 2018 (American Chiropractic Association, 2018).
For many years, like many of you, I viewed “guidelines” as a negative, however, I am now singing a different tune. This and many other battles have been fought and won because of the existence of these guidelines and the research that supports them. The mission of the Clinical Compass (CCGPP) is to gather and evaluate existing evidence‐based practice information, to facilitate the development of new information where existing evidence is lacking, and to distribute and assist in the implementation of evidence‐based practice information that is relevant to the chiropractic profession. For over twenty years, many have taken several hours each day away from their practices and their patients, to work for the advancement of our profession. They are the unsung heroes of chiropractic. As one board member, Dr. Greg Baker (Georgia), said, “Research is a great weapon.” As the situation with UnitedHealthcare shows, he couldn’t be more right. Take a minute to thank the men and women below for helping to fight and win the battles that many are not even aware of,so that we can continue efforts to help our patients. And, just as importantly, challenge polices by payers and decision makers that are not consistent with the current research.
To hear how our profession came together to fight, and win the battle with United Healthcare, watch the video at the top of this page.
Clinical Compass Board Members:
Jay S. Greenstein, DC, CCSP, CGFI-L1, CKTP, FMS – Chairman
Louis Crivelli, DC – Vice Chairman
Scott Mooring, DC, CCSP – Secretary
Jeff Askew, DC – Treasurer
Gregory A. Baker, DC – Past Chair
Wayne Whalen,”. DC. FIACN, FICC – Chairman Emeritis
Bradley Russell, DC – ACA
Steven R. Conway, Esquire – NACA
Tom Wetzen, DC – COCSA At Large Director
Thomas J. Augat, DC, MS, CCSP, FASA – COCSA District 1
Kendall Payne, DC – COCSA District 2
RJ Crawford, DC – COCSA District 3
Kris Anderson, DC – COCSA District 4
David Paris, DC – COCSA District 5
Cheryl Hawk, DC, PhD – Commission
Claire Johnson, DC. MSEd, DACBSP, FICC – Commission
Amy Minkalis, DC – Commission
Janet Jordan, CAE – Administrator
Ray Foxworth, DC – Contributor/Representative