May 2005

Blue Cross calls chiropractic for children 'experimental'

Has begun denying claims for kids' care

Several DCs in Maryland recently received notification from CareFirst BlueCross/BlueShield denying their claims for chiropractic care given to children under the age of 12.

According to the insurance company letter, "the CareFirst Medical Policy Committee considers spinal manipulation services to treat children 12 years of age and younger, for any condition, to be experimental/investigational."

The company's policy also states: "Spinal manipulation services for treating non‑musculoskeletal disorders such as asthma, hypertension, gastrointestinal disorders, infections, fatigue, or mental and nervous conditions are considered 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.

William M. Sonak, DC, one of the doctors who reported a claim rejection to the World Chiropractic Alliance, noted that, until recently, he had been paid for care provided to an infant but those claims were now denied.

"I have taken care of many children under 12, and if it weren't for chiropractic adjustments at a young age, I probably would still have asthma and allergies," he stated. "Lucky for me, the chiropractor I went to did not view chiropractic for children as 'experimental.'"

Although many DCs were surprised by the claims rejections, the policy of labeling chiropractic care as experimental or investigational is not new or uncommon. "Chiropractors need to understand that the parameters they used to develop their policy are really not new," explained Matthew McCoy, DC, editor of the Journal of Vertebral Subluxation Research and vice‑president of the Council on Chiropractic Practice. "Every insurance company has a policy by which they decide whether a procedure is experimental/investigational. The issue is whether or not they enforce it and clearly this is one area where they are choosing to do so."

The CCP's Guidelines, "Clinical Practice Guideline Number 1, Vertebral Subluxation in Chiropractic Practice," supports chiropractic for people of all ages, including 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.

Dr. McCoy added that, until the profession conducts extensive scientific research into the efficacy and safety of chiropractic for children, however, it will be difficult to force insurance companies to change their policies. "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.