Question
QUESTION: So I went to the Chiropractor today to get my back adjusted cause it was hurting.  I told him I had new insurance.  He said he would take a copy of it but wouldn't be submitting a claim because it would be denied because I am in a "maintenance" period of care.

I have always had an HMO plan before with no deductibles to worry about but we just switched to BCBS with a high deductible plan.  I told him that I understood it wouldn't get paid, but wanted it submitted so it could go against my deductible.  He said he couldn't do that cause the insurance company would probably actually just pay it but it would set him up for an audit.

My back and hips were really hurting... so I went ahead and got adjusted (and feel GREAT now)... but I'm thinking something is not right here.
Is it normal practice to not even file the visits to the insurance office?  (He told me other people do it but it is illegal or wrong or something along those lines.)  If I went to my regular doctor cause I thought I was sick.. but turned out I was fine, they would file the claim regardless...  Why won't he?  (My theory is he is charging me more than my insurance company would actually pay him OR that maintenance visits are a crock of *** and that's why he won't file.- but my back HURT... so it wasn't really maintenance.)

ANSWER: Lisa,

Sadly, your chiropractor is correct in that some plans have it written in their contract that they do no cover for "Maintenance" or "wellness" care.   If you're stating that your back was really hurting, and that you were fine prior, then your chiropractor should reconsider how he is documenting your care.  I don't know what your previous record is for treatment, but in the eyes of the insurance company (they have the check book and they write the contract) if you always have back pain every 4 weeks, they will perceive it as maintenance of your condition.   Technically, they could go after the chiropractor and make his life miserable.   It's a really dumb, biased, short-sighted, and unfair insurance system, but it's the system we have to live in right now.  Many doctors find creative ways around it.   So the question you must ask your DC is, "How come the visit is considered to be 'maintenance' care?"    I don't know about you, but if a patient feels fine for a while and then has a flare up of back pain, it sure doesn't sound like maintenance care to me.  

'Hope this was helpful.  

Dr. G

---------- FOLLOW-UP ----------

QUESTION: I have had back problems for about 12 years.  It comes and goes.  But last October when picking up my 3 month old... I could finish standing.  I ended up going daily for a week, then 3x/wk for 3 wk, 2x/wk for 3 wk, 1x/wk for 3 wk, every other wk for 3 wks, 1/mth for 3 mths.  My chiropractor then felt my back was stable and suggested I come in for "maintenance" visits, but would have to cover the cost of them.  I never really went for any maintenance visits.  I have been back maybe 2 or 3 times since then when my back was hurting.  

I found some other info online that suggests that "maintenance" visits are not actually necessary.  Is there any proof that it really works?

And thank you very much for your response.  I was very worried that my chiropractor that I LOVE was somehow trying to dupe me.  

Answer
There is no proof that maintenance works to maintain anything.  Sorry.  Some patients feel that it does, others not.   Some get the same back pain flare ups whether you adjust them monthly or not.   Exercise!  That may be a major factor.  And I've observed a trend of patients needing less care when they exercise regularly.   As a chiropractic patient myself (I'm human, too), I become very aware when my body is not working well.  Sometimes there is no pain, just an odd sense of soreness.  Often I feel a notable sense of weakness when performing certain exercises at the gym.  There clearly is a difference in how I feel when I get basic chiropractic manipulation along with a little soft tissue prep to my spine and pelvis.  I know I'm not alone in feeling these things.  But, unfortunately, there is no research to demonstrate what I and others experience.   So when I go, is it maintenance?  I'd say no.   I go when I want and when I don't feel right.  Sometimes I go when I hurt myself (like after wiping out on a snowboard) but that's unquestionably not a maintenance visit.   You had a lot of treatment for your back pain...maybe there was no insurance benefit left...but in the insurance's eyes, with a pre-formulated plan of 4x/week, 3x/week, 2x/week, etc, the 1x/month sure looks like maintenance.     

'Regards,

Dr. G