April 2005, Vol. 15, Iss. 2

Table of Contents

Altered Cervical Lordosis and DJD • Chiropractor Invents Car Seat Headpiece • DACBRs Cause Professional Embarrassment at RAC • Eight Major Aberrant Forms of the Lumbo-Pelvic Spine • European Spine Journal to Publish 6th CBP® Clinical Control Trial • Evidence Based or Not • Glutamate/Aspartame - Pain and Your Brain • Greg Buchanan Donates $30,000 to CBP® Nonprofit • Inappropriate Characterization of CBP® Technique • Missed Appointments and Patient Education • Money, Taxes, Life and Practice • Palmer College Takes Alumni Group to Court • PosturePrint™ Research with ICA • Presenting Defendable Care Options to Patients • Published Papers Near 81 • Resign or be Terminated • Thermography: Renewed Interest • Using Silence to Communicate • Whiplash Injuries: Pathophysiology, Diagnosis, Medical Management and Prognosis

back to front page

Resign or be Terminated

by James R. Sieffert B.Sc., D.C., C.C.S.P., C.S.C.S.

1994 graduate from Northwestern College of Chiropractic. District Delegate to the Arizona Association of Chiropractic (AAC), Vice-Chair of the AAC’s Insurance & Health Services Committee

               This is a choice I recently had to confront due to a well known national chiropractic network.  As CBP® doctors, we typically remain out of network because we know that the interest of most payors is to only get the patient out of pain and make profits, not really advance their health, especially when it comes to chiropractic and structural care.  I had chosen to remain in this network because historically I had received a large number of patients from their major contract in Arizona (and incidentally their parent company), when they were contracted with a different network.

              Since the new network has taken over, the advantage to being in network has pretty much dried up, and I guess shift in focus in my practice (more management and less patient care), or complacency led me to remain in network.

              In Arizona, we have one of the most favorable Unfair Claims Settlement Practice Acts in the country.  In ARS 20-461, it states, “Nothing in this section shall be construed to prohibit the application of deductibles, coinsurance, preferred provider organization requirements, cost containment measures or quality assurance measures if they are equally applied to all types of physicians...”.  I felt the network was not equally applying their cost containment measures when compared to MDs and DOs.  The network periodically would call to “counsel” doctors on their statistics compared to their peers.  The last time they called, I refused to discuss it with them quoting ARS 20-461 for my stance.  I asked if the network or the parent company also did the same type of statistical analysis and “counseling” for MDs and DOs, and if so, to provide proof.

              Approximately a month later, I received a letter with a Performance Improvement Agreement that I was required to sign to maintain my status in the network.  Instead I wrote them a letter resigning and picking apart their statistical analysis, their use of self-gathered statistics above peer-reviewed published protocols and again asked for proof on equally applied treatment for MDs and DOs.  My letter was also well referenced.  I also asked why the network only compared me to statistics on in network doctors and not out of network or self-funded plans.  Did who paid the bill change the way patients were treated?  I also asked how they could compare apples to oranges, and that I would be happy to provide them with names of doctors in my state that have similar outcome objectives as myself.

              I also called and discussed these issues with the CEO of the network.  His final opinion was that structural care was investigational, and though he agreed he would personally prefer to have normal structural biomechanics, he did not believe it was the duty of health insurance to pay for it at this time.  He also informed me, at that time, that they are gathering statistics out of network and are in the process of having their statistics analyzed by an outside company.

              At first thought, I thought this was a good thing for the profession to have an outside company validate their statistics.  Then with a little more thought, I realized that this could be one of the worst things facing our profession at this time.  If a company hired by the network “validates” their statistics, they could use that as the “standard” for both out and in network providers.  How would you like to be limited to 6 visits, no matter what, or one therapy or rehab code per visit, or the majority of your patients couldn’t be adjusted more then 1-2 regions or have X-rays?  Let alone follow up views.