Section 8

Frequency and Duration of Care

A growing number of insurance carriers are imposing "caps" on chiropractic services. Some policies specify a maximum number of visits or a dollar limit for chiropractic services in a given year. Other policies have de facto caps. These are the "red flag" criteria which trigger review of a claim. Although there may be no pre-defined limit for chiropractic services under such policies, claims exceeding the "red flag" threshold are likely to be cut. The issue is further complicated by the fact that the "red flag" criteria are often held secret by the carrier. Thus, the chiropractor has no way of knowing what criteria the carrier uses in evaluating claims.

The Mercy Center document defines an "adequate trial of treatment/care" as follows: "A course of two weeks each of two different types of manual procedures (four weeks total) after which, in the absence of documented improvement, manual procedures are no longer indicated." In the RAND Corporation document, we find a very similar recommendation. RAND also defines a favorable response as "an improvement in symptoms." Why should chiropractors accept such limitations, particularly when RAND admits, "There exists almost no data to support or refute these values for treatment frequency and duration?"

Would the medical profession accept a similar limitation? Do their standards state, "An adequate trial of medical care is the administration of two drugs for two weeks each after which, if symptoms do not improve, medical care is no longer indicated?" What about a hypertensive patient who is asymptomatic malignancy metastasizes to bone and causes pain before initiating treatment? Should dentists be prohibited from filling asymptomatic cavities?

It must be clearly understood that the need for chiropractic care is based upon objective evidence of subluxation not symptoms.