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Dynamic Chiropractic – April 9, 2007, Vol. 25, Issue 08

United Healthcare: Here They Go Again

By James Edwards, DC

The American Chiropractic Association (ACA) has received reports that United Healthcare has implemented a new policy in several states to only reimburse physical medicine and rehabilitation (PM&R) services when performed by a licensed provider.

The new policy states, "PM&R services rendered by non-licensed individuals are not eligible for reimbursement, regardless of whether they are supervised by, or billed by a physician or other licensed therapy provider." This change is effective as of Jan.

1, 2007 for newly contracted providers and April 1, 2007 for currently contracted providers.

So, what exactly does this new policy mean for doctors of chiropractic? In Texas, where United Healthcare is applying the policy, it means a doctor of chiropractic will not be reimbursed for physical medicine or rehabilitative treatments unless those services are actually performed by the doctor or by a person licensed by the state to do so, such as a physical therapist. In other words, if you are a non-licensed chiropractic assistant who applies a heat pack or assists a patient with rehab, you will not be reimbursed! Think that might change the way you practice?

As this change will greatly impact patients and providers across the country, the ACA is reviewing all possible legislative and administrative remedies while consulting with leading chiropractic associations and their legal counsel to strategize the best course to follow. And if legal action or administrative relief is sought, who will pay the "lion's share" of that cost? Well, the National Chiropractic Legal Action Fund (NCLAF), of course.

The NCLAF has repeatedly told the chiropractic profession that the concern is not if our adversaries will attack us again, but when they will attack us. And sure enough, here they go again. Fortunately, the NCLAF shifted its focus to building a legal "war chest" for just this type of attack, and has reserves ready to commit to the fight. The ACA and the NCLAF continue to protect and defend your practice, your patients and your profession. If you are not an ACA member, then join! If you are not a monthly NCLAF contributor, then start!

Click here for more information about James Edwards, DC.

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