Study Finds the Availability of Chiropractic Care Improves the Value of Health Benefits Plans
CALIFORNIA: A report, prepared by a global leader for trusted human resources and related financial advice, products and services finds that the addition of chiropractic care for the treatment of low back and neck pain will likely increase value-for-dollar in US employer-sponsored health benefit plans. Authored by Niteesh Choudhry, MD, PhD, and Arnold Milstein, MD, the report can be fully downloaded at: http://images.vortala.com/chiropractor/USA/California/Carmichael/Foundation%20for%20Chiropractic%20Progress/SiteGraphics/ChiropracticServicesReport.pdf.
Accordingly, this report was commissioned by the Foundation for Chiropractic Progress (www.f4cp.com) to summarize the existing economic studies of chiropractic care published in peer-reviewed scientific literature, and to use the most robust of these studies to estimate the cost-effectiveness of providing chiropractic insurance coverage in the US.
According to Gerard Clum, DC, spokesperson for the Foundation for Chiropractic Progress and President of Life Chiropractic College West, while some studies reflect cost efficiencies and others clinical efficiencies, these findings strongly support both for chiropractic care of neck pain and low back pain.
High quality randomized cost-effectiveness studies have, to date, only been performed in the European Union (EU). To model the EU study findings for US populations, researchers applied US insurer-payable unit price data from a large database of employer-sponsored health plans. The findings rest on the assumption that the relative difference in the cost-effectiveness of low back and neck pain treatment with and without chiropractic services are similar in the US and the EU.
These findings, in combination with existing US studies published in peer-reviewed scientific journals, suggest that chiropractic care for the treatment of low back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favorably to most therapies that are routinely covered in US health benefits plans.
State Orders Horizon to Pay Chiropractors’ Claims
NEW JERSEY: The Association of New Jersey Chiropractors says that the state Department of Banking & Insurance has ruled the state’s largest health insurer must end its practice of not paying the separate claims of chiropractors for patient exams and physical therapies.
The association said Horizon Blue Cross Blue Shield had been bundling the claims into reimbursements for general chiropractic treatment, subjecting them to the limits of single claims and effectively denying them.
Department of Banking and Insurance (DOBI) Commissioner Neil N. Jasey issued a cease and desist order Oct. 7, directing Horizon to treat chiropractors’ claims the same way as other health care provider claims.
Horizon had been denying the claims for exams and physical therapies since 1997, when it switched its claim codes, according to Jeffrey Randolph, the lead attorney for the Association of N.J. Chiropractors.
The American Chiropractic Association began challenging the claims denial in 2004, Randolph said, and the state organization took over the legal challenge a year later, since it represents New Jersey’s 3,200 chiropractors, 1,500 of whom are association members.
Horizon limited its comment on Jasey’s ruling to a brief statement: “Horizon Blue Cross Blue Shield of New Jersey has received the decision that was rendered by the state of New Jersey’s Department of Banking and Insurance. Horizon BCBSNJ is in the process of reviewing and analyzing the ruling.”
Dr. Sigmund Miller, executive director of the Association of N.J. Chiropractors, said the association is exploring possible strategies, including legal ones, for practitioners to recoup past unreimbursed claims.
Randolph said claim-submission deadlines impose restrictions from 180 days to a year plus 90 days, depending on the health insurance plan. Horizon was given 45 days in which to appeal Jasey’s administrative action.
Federal Red Flag Rules Apply to Doctors of
Chiropractic Starting June 1, 2010
Legislation abolishing physician participation passed in House awaits Senate action
Federal Trade Commission (FTC) regulations stating that financial institutions and creditors are required to develop and execute written identity-theft prevention programs, otherwise known as the “Red Flags Rules,” are slated to go into effect June 1, 2010.
Earlier this year, there was much ambiguity regarding the regulations and questions were raised as to whether physicians’ offices fell under the FTC red flags guidelines. In February, the FTC issued a statement clarifying that Identity Theft Red Flag Rules do indeed apply to physicians, including doctors of chiropractic.
The FTC has delayed implementation of the Red Flag Rules until June 1, 2010. The Senate has not yet taken action on this issue but, in an Oct. 30 release, the FTC indicated it did not want to begin enforcing a regulation that Congress plans to supersede. Therefore, the FTC pushed back the implementation date of the regulation from Nov. 1, 2009, to June 1, 2010. Read the FTC’s release, and look for updates on this issue in ACA publications.