Chiropractors blast UnitedHealthcare’s ‘fundamentally flawed’ policy shift on spinal manipulation

Chiropractor showing model of spine to patient
The American Chiropractic Association says UnitedHealthcare's coverage change for spinal manipulation may violate federal law. (Getty/Wavebreakmedia)

A national chiropractic association is threatening legal action against UnitedHealthcare over a recent policy change that pulled coverage for an alternative therapy for patients with severe migraines.

In a letter to UnitedHealthcare CEO Dan Schumacher, American Chiropractic Association (ACA) President N. Ray Tuck Jr. said he was “astounded” to find out the insurer would no longer cover chiropractic spinal manipulative therapy (SMT) for patients with migraines and severe headaches.

The letter, which was also signed by more than two dozen state chiropractic associations, said UnitedHealthcare no longer covers the treatment, labeling it “unproven and/or not medically necessary.” The groups pointed to eight studies over eight years that support the use of spinal manipulation, including a March study that showed the treatment could reduce the frequency of headaches by 30%.  

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“As a result, health plan beneficiaries will be improperly denied chiropractic services for the treatment of headache—services many of them have come to rely upon,” the letter (PDF) stated. “The use of this flawed policy constitutes, in our view, a breach of fiduciary responsibility for a health plan administrator who must ensure that the plan claims are decided in accordance with plan documents and valid evidence.”

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The organizations said they planned to help patients challenge the flawed guidelines under Employee Retirement Income Security Act of 1974 (ERISA) appeals procedures and notify employers that the policy “may violate plan-governing documents.”

Annette Bernat, ACA’s vice president of communications and external affairs, said UnitedHealthcare is the only insurer that doesn’t cover SMT “as far as we know.”

UnitedHealthcare did not respond to a request for comment. 

Broadly, the Department of Health and Human Services Office of Inspector General (OIG) has frequently warned about the need to control fraud, waste and abuse tied to chiropractic services in the Medicare program. Chiropractic services have the highest improper payment rates among Part B services, according to a February report (PDF), accounting for as much as $307 million in overpayments each year.

At the same time, state attorneys general have urged insurers to help rein in opioid prescriptions by using alternative therapy treatments like physical therapy, acupuncture, massage and chiropractic care. Others, like American Specialty Health, are pushing for broader use of alternative therapies to help combat the opioid epidemic. 

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