Aetna chiropractor

Aetna Chiropractor? Your Payments Are in Jeopardy if You Adjust, Do Rehab or Don’t Follow Their Latest Policy Updates!

If you are an Aetna chiropractor, receiving payment for many of your services may now be in jeopardy thanks to three of their recent policy updates: one for chiropractic services and one for complementary and alternative medicine (both updated in June) and physical therapy services (updated earlier this year).

The bad news is that this will affect all chiropractors – regardless of whether you are in or out of network with Aetna.

The good news, which admittedly, isn’t all that great, is that you are reading this now and hopefully before your payments are impacted by the new policies and preparations can be put in place.

Changes to Aetna’s Chiropractic Policies

Every insurance payer has routinely scheduled reviews of their policies and if you are an Aetna® chiropractor, you are not a target of some sort of specialized treatment.  I say this because Aetna’s policies may make you feel as if there is a target on your back; but the reality is that policy reviews do happen routinely and affect all provider types – not just DC’s.

What makes the latest policy feel like a personal attack against Aetna chiropractors is the fact that the June 2018 update has more than its fair share of chiropractic techniques singled out as “experimental” or “investigational” and therefore, not payable. Check out these examples which are numerous, but unfortunately true:

A quick review of policy document will reveal that Aetna apparently does not like the following chiropractic techniques:

  • Activator
  • Advanced Biostructural Correction (ABC) Chiropractic Technique
  • Applied Spinal Biomechanical Engineering
  • Atlas Orthogonal Technique
  • Bioenergetic Synchronization Technique (BEST)
  • Biogeometric Integration
  • Blair Technique
  • Bowen Technique
  • Chiropractic Biophysics Technique (CBP)
  • Coccygeal Meningeal Stress Fixation Technique
  • Cox decompression manipulation/technique
  • Cranial Manipulation
  • Directional Non-Force Technique
  • Gonzalez Rehabilitation Technique
  • Koren Specific Technique
  • Network Technique
  • Neural Organizational Technique
  • Neuro Emotional Technique
  • NUCCA
  • Sacro-Occipital Technique
  • Webster Technique (for breech babies)
  • Whitcomb Technique

As if that list wasn’t large enough, if you are an Aetna chiropractor, you should also know that the following instruments or equipment can get you into some payment problems:

  • Activator
  • Denneroll posture regainer
  • Pilates (equipment)
  • Proadjustor
  • Pulstar
  • Wobble Chair

Now, if you happen to be an Aetna chiropractor who does rehab work, you should be aware that Aetna is against the following rehabilitative methods or that are frequently used by chiropractors:

  • Active Release Technique
  • Advanced Therapeutic Movement (ATM2)
  • Airosti
  • ConnecTX (an instrument-assisted connective tissue therapy program)
  • FAKTR (Functional and Kinetic Treatment with Rehab) Approach
  • Kinesio taping
  • Pilates

The Disclaimer, the Damage & the Dead Serious Implications

Unfortunately, the above are only a selected few of the techniques, methods, instruments and services that can be denied if you are an Aetna chiropractor who is utilizing them.

So, yes, that means that there are others on their “hit list” that can potentially cause you just as much, if not more, damage if you use them more often.

And if you are inclined to read through the entire policy documents listed above as I am, there is one dead-serious glaring observation that can be made:  Aetna does not appear to like much of what we do as chiropractors.  Nor do they like massage, physical therapy or most of what they would label as “alternative medicine” – which is a pretty broad list.

What to Do Next

The first step here is awareness.  You cannot fight an enemy you don’t see.

The second is to choose the battles you will fight.  If you are an Aetna chiropractor and their patients form a significant portion of your patient base, then you will have to wrestle with these policies within your practice and within your state.  But it may require national strength to change this policy behavior as well.

The alternative is to do nothing which amounts to sitting back and taking your lumps. For some folks who don’t see many Aetna patients, this may appear to be a decent approach – until these type of policies pollute the waters of other payers as well.  Then, you’ll be forced to take up arms or get out of the battle altogether, which certainly is a legitimate alternative.

In the meantime, forewarned is forearmed.

NEED ADDITIONAL HELP

Navigating policy changes (for Aetna and other payers) so that you can get paid for the work you do is just some of what I will be teaching in my upcoming Smarter Chiropractic Seminars  where we will be teaching Best Practices for Profitable & Compliant Chiropractic, Massage & Rehab Billing, Coding, Documentation & Business Strategies So You Can Work SMARTER in 2018, Not Harder!

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