Medically Necessary Chiropractic Care
Did you know Chiropractic care can be considered medically necessary?
When a physician provides a service for the purpose of evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms thereof. If, after evaluation, it is determined that Chiropractic care is a viable treatment option, a customized treatment plan is developed for the patient, usually covered by insurance.
It is common in this situation to begin treatment with more frequent visits (which we call the active care phase) and then taper off to less frequent visits over time. As long as the patient is showing improvement over a reasonable amount of time the treatment is considered medically necessary.
However, there are several problems with this policy.
The first is the rarity of Chiropractic care being designated as medically necessary. Oftentimes, the only “medically necessary” cases are in response to accidents or injuries, or perhaps illness. [1]
The second is the fact that insurance fails to cover care beyond the active care stage of treatment. The designation that the patient must be consistently showing improvement is, in the eyes of Chiropractic, flawed.
Why?
Chiropractic Care: The Difference Between Maintaining Health and Poor Health
Because chiropractic care isn’t just about responding to poor health. It’s about maintaining good health.
However, based on medical recommendations and insurance limitations, this truth is frequently buried. We base our treatment needs off of reactions to a need for care that manifests in pain, mobility issues, or illness.
Chiropractic bases care off of the need not only to improve health (corrective care), but also to maintain it once it has improved (wellness care).
What’s the Difference Between Active and Corrective Care?
Corrective care is designed to treat an underlying issue that has manifested in a symptom, such as back pain. Corrective care is the second stage after medically necessary active care has been completed. While active care works to control immediate symptoms affecting the daily life of the patient, corrective care works to improve the condition itself, beyond simply relieving symptoms.
Corrective care includes pre- and post-X-rays to evaluate the progress of the spine due to restorative techniques that help return the spine to it’s natural alignment and improve function via the nervous system.
While the goal of active care is to relieve pain and other immediate symptoms, the goal of corrective care is to uncover and treat the root cause of recurring symptoms, loss of function, or disease.
Corrective and active care do have the potential to overlap, which means there is potential for insurance coverage of corrective treatment, but only if they meet the requirements for active care as determined by your healthcare plan provider. Unfortunately, these requirements often leave you without the full care you need to seek effective Chiropractic care for the necessary period of time.
The Chiropractic Care Struggle: The Insurance-Wellness Dilemma
Chiropractic care isn’t the only area where the red tape of insurance coverage causes unexpected health expenses either. In America, we have the highest average spend per capita on healthcare in the developed world, and also, ironically, lead the charge in chronic “lifestyle” diseases (diabetes, heart disease, obesity, mental illness).
When you take a moment to look at the numbers, the discrepancy is staggering. The average insurance premium for a single person in 2019 was $7.188, and the average for an employer-based insurance plan for a family was $20,576. And, as if that isn’t enough, insurance increases have outpaced wage growth with insurance costs up to 26% in the last decade. [2]
In other words, we are spending premiums on insurance that may fail to cover the care that we need to be truly healthy in the long term.
Wellness Care
At MaxLiving, we operate for the sake of wellness, helping patients move beyond the cycle of active care and into the healthy lifestyle of wellness care.
Unfortunately, insurance does not often cover wellness care, because it is not considered active care, and therefore is not ‘necessary.’ Under the Medicare Program, Chiropractic wellness care is not considered medically necessary, and therefore is not payable. [3]
And yet, wellness care focuses on maintaining health in order to prevent further costs to both your health and your wallet.
If Chiropractic can provide support for continued wellness, why then, is it not considered important care?
Simply put, because our system is focused on improvement, rather than stabilization.
Are You Functioning at 100%
Our bodies only have the capacity to function at 100%. We cannot improve further. We can, however, degrade to function at 90%, or 80%, or even less. Without any interference, our natural state is 100% functional and healthy. But as soon as we interact with our environment, we begin to be affected by outside factors that decrease that level of health.
Typically, it takes a whopping 40% degeneration of the affected system in order for patients to recognize symptoms such as pain. [4] In a system focused on improvement over maintenance, this means that our bodies are allowed to decrease in health and function until it becomes a source of pain or illness, at which point medical intervention is necessary to improve.
This of course, creates a cycle. We are cared for to treat a health problem, our symptoms improve, and our functionality increases. Then insurance coverage ceases, and with it care. From this point, your body begins the process of degeneration all over again until you need active care once more.
Exhausting, isn’t it?
Wellness Care is the Core of MaxLiving
This is why, at MaxLiving, we focus on wellness care. Wellness care is designed to maintain the progress made during active and corrective care, and reduce the probability of future recurrence of the same issues.
We believe that 100% health and function is a choice that requires active engagement in the continual practice of promoting wellness, which is what we provide for our patients each and every day.
Though insurance oftentimes ignores wellness care, that does not necessarily make it a greater personal health expense.
Ongoing wellness treatment may not be covered by your insurance policy, but the amount you can save in doctor visits, deductible costs, insurance premiums, and the like may far outweigh that expense.
Remember, families are spending over $20,000 on average for a family insurance plan each year. And that’s without an unexpected health emergency, which is increasingly likely in a country where lifestyle diseases are on the rise.
How would you like to chip away at those expenses while also supporting continual wellness throughout your life?
That is what wellness care seeks to provide.
If you are interested in transforming your health for the better, find a MaxLiving Chiropractor and clinic near you today: https://maxliving.com/locations/
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More on the Power of Chiropractic Care
About the Author
Shel Hart is the CEO of MaxLiving, where leads our network of 190 chiropractic clinics to help reach more patients so they can impact more lives. He is a proven entrepreneurial leader with demonstrated experience within both public and private companies. Skilled in increasing shareholder value through consistent delivery of incremental, sustainable, predictable and profitable results.
References
[1] https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf
[2] https://www.cnbc.com/2019/09/26/health-insurance-premiums-increased-more-than-wages-this-year.html#:~:text=The%20average%20annual%20premiums%20for,%2C%20respectively%2C%20increase%20over%202018
[3] https://www.medicare.gov/coverage
[4] https://my.clevelandclinic.org/health/diseases/16912-degenerative-disk-disease
