All patients should be aware of federal and state insurance laws that prohibit insurance companies from discriminating against chiropractic services and require services provided by chiropractic doctors to be covered to the same extent as services are covered for medical doctors.  These laws are primarily for the health care consumer. Awareness of these laws will help you to make the best use of your health insurance benefits. This should help you achieve the opportunity to select your chiropractic physician for your general, primary and/or specialty care needs. The health insurance laws should assure you are able to receive the full scope of chiropractic services allowed under the law. Your health insurance policy may not comply with federal and/or state insurance laws.

To be compliant with federal and state laws, insurance company policies must provide the following:

1.     Listing on the internet or any publication of chiropractic physicians must be under the category of physicians. The four physician qualified whole person healing arts disciplines include medical, osteopathic, chiropractic and naturopathic professions. These professions care for the whole person and not just a body system or region. The chiropractic profession must be listed with medical and osteopathic physicians in the Essential Health Benefits Benchmark Plan which is followed by all insurers. This is a table of benefits with a description of coverage each insurer uses to inform subscribers of benefits included in their plan. Chiropractic is not only a rehabilitative therapy and should not be listed in this category with physical and occupational therapists. Chiropractic is a physician level healing art which must be listed with physicians.

2.     Chiropractic doctors must be recognized, categorized, listed and offered to subscribers for primary care (pediatrics, internal disorders) with the opportunity for patients to select their chiropractic physician for primary care.

3.     Chiropractic doctors must be recognized, categorized, listed and offered to subscribers for specialty care (orthopedics, neurology, sports medicine, rehabilitation, nutrition, radiology and others) with opportunity for patients to select their chiropractic physician for specialty care.

4.     Chiropractic and medical coverage including reimbursement schedules must be equal (“to the same extent”) and based on identical formulas to allow for the doctor’s time provided for patient care with respect to the severity of the patient’s condition and standard practice overhead costs. A reimbursement schedule which pays a global fee or per diem rate for the office visit, regardless of the amount of time required to provide reasonable, safe and effective care, is not congruent with a reimbursement schedule which pays a fee for each service that factors the time spent with the patient in order to provide reasonable, safe and effective care. As a result of unequal reimbursement schedules, patient access to the chiropractic physician’s full scope of services cannot be provided. For co-payment policies:

o   The co-payment for chiropractic generalist or primary care evaluation and management and consultation visits should be identical to primary care visits provided by medical doctors.  These rates should be the same since they are both providing primary care services.

o   The co-payment for chiropractic specialist evaluation and management and consultation visits should be identical to specialist visits provided by medical doctors. These rates should be the same since they are both providing specialty care services.

o   The co-payment for physical treatments provided by the chiropractic physician should be identical to physical therapy co-payments ordered by primary or specialty care medical doctors. These should be the same since the physical therapy co-payment is limited up to $30.00 per visit by statute. This favors a medical doctor’s treatment plan and fails assure chiropractic coverage “to the same extent” as coverage is provided for a medical doctor.

5.     Treatment limits for chiropractic doctor office visits and physical treatments must be equal to medical doctor limits. Chiropractic doctors are limited to 20 visits per year in the Benchmark Plan. There are no limits to a medical doctor’s office visits and physical treatments.

6.     There can be no generalized restrictions of conditions treated by a chiropractic physician. The chiropractic scope of practice recognizes treatment of the human living body with no restrictions of care to a particular body region or system. Some insurance companies limit chiropractic treatment to neuromusculoskeletal conditions. Medical doctors have no such limitations.

7.     There can be no age restrictions for coverage where chiropractic manipulative therapy is provided. The Benchmark Plan excludes manipulation of the cervical spine for children under 12 years of age. There are no known restrictions to medical doctors.

Connecticut Chiropractic Association

Insurance and Government Relations Committees