Attention DCs: Information About Discriminatory Practices by Health Plans
November 02, 2018

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From the Managed Care & Insurance Committee

The CalChiro Managed Care and Insurance Committee (MCIC) has engaged with several health plans who offer and administer health care benefits to Californians. These discussions have centered around discriminatory policies and positions by non-payment or discriminatory payment for similar services offered by other health care practitioners. CalChiro’s position is that if services are available to licensed health care practitioners, whose scope of practice allows those services to be performed, services performed by doctors of chiropractic should be similarly reimbursed – again, so long as those services rendered by doctors of chiropractic are within the scope of chiropractic practice.

During these discussions, health plans have informed CalChiro of the claims data mining performed on claims submitted by doctors of chiropractic. These health plans have indicated that with increasing frequency, doctors of chiropractic are submitting claims only for reimbursement of physical therapy services, and as a result the health plans are concluding that there are doctors of chiropractic who appear to be holding themselves out as physical therapy practitioners – a violation of several regulations governing the practice of chiropractic. CalChiro is not currently aware of any increase in state board complaints on this issue, but the fact that this information is being gathered is of concern to the association.

We write today to advise you of this information. CalChiro continues to question the health plans on the results of their data mining and will keep the members apprised of the information and discussions as we proceed. As doctors of chiropractic, our primary treatment intervention is Chiropractic Manipulative Therapy – and the scientific research conclusively supports our delivery of this service – and we continually present this evidence to health plans. As we have requested in prior communications, any information your office receives that shows discriminatory practices by health plans, please submit to the CalChiro office as this information will support our position that discrimination does exist in the policies and positions by health plans. Please send your documentation to dbenton@calchiro.org or fax to 916-648-2738.

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