August 2005

BC/BS kid denials spreading

What started with a few isolated cases in Maryland is rapidly spreading across the country as other insurance companies, notably Blue Cross/Blue Shield (BC/BS) plans, begin enforcing a policy that refuses to pay claim for chiropractic care for children. Most of the policies echo the one formulated by Maryland's CareFirst Medical Policy Committee and state that "spinal manipulation services to treat children 12 years of age and younger, for any condition, to be experimental/investigational." Although the policy has been in effect since 2001, a review in March of this year has apparently spurred the wave of rejections, which many chiropractic experts say may expand throughout the country.

The most recent reports of similar claims rejections came from Wisconsin and Minnesota, where similar reasons were given for the denials. Although most companies have had similar policies for years (The CareFirst policy was written in 2001), a review earlier of this year has apparently spurred the wave of rejections.

Although representatives from the American Chiropractic Association (ACA) reportedly met with BC/BS in 2004, they weren't able to convince them of the safety or efficacy of chiropractic for children. According to a report by Garrett F. Cuneo, ACA executive vice president, published on the ACA website, "They asked for research data on the treatment of children. We provided them with some, noting that studies on medical care for kids are also few and far between."

Matthew McCoy, DC, editor of the Journal of Vertebral Subluxation Research and co‑founder and vice‑president of Research & Clinical Science (RCS), said that the ACA assessment was at least partially correct. "As chiropractors we can complain all we want that the policy is not fair, that they are holding us to a different standard etc., but the bottom line is a dearth of chiropractic research in this area that meets their standards and we must change that," he noted.

The World Chiropractic Alliance (WCA) has begun helping doctors fight the policy, however, by encouraging doctors to arm themselves with information about chiropractic and children to dispense to their patients, as well as to insurance companies.

Two important documents to have on hand are the WCA's "Policy Statement on Chiropractic for Children," and a copy of the Council on Chiropractic Practice Guidelines, which clearly supports the use of chiropractic for children.

"Since vertebral subluxation may affect individuals at any age, chiropractic care may be indicated at any time after birth," the document states. "As with any age group, however, care must be taken to select adjustment methods most appropriate to the patient's stage of development and overall spinal integrity. Parental education by the subluxation‑centered chiropractor concerning the importance of evaluating children for the presence of vertebral subluxation is encouraged." It rates chiropractic for children as an "established" practice and provides extensive documented evidence to support its position.

 "While additional research is being conducted by RCS and others, the World Chiropractic Alliance will continue to put pressure on insurance companies and educate the public about the benefits of chiropractic for children," stated Terry A. Rondberg, DC, WCA president. "We have to let parents know that subluxation correction in children is extremely important to safeguard their future health and wellness."

The WCA holds two major Children's Health Day International health fairs each year with DCs around the world providing information and screening services to their communities.