Pacific Mutual's reclassification of MUAs from "experimental" to "equivocal" is based on the recommendation of the Mercy Guidelines and demonstrates the credibility of practice guidelines, particularly the Mercy Guidelines.
There has been concern in some quarters that procedures not rated as "established" by the Mercy Guidelines would not be reimbursed, obviously not the case with Pacific Mutual.
August 30, 1993
Bradley J. Sullivan, DC, President
California Chiropractic Association
7801 Folsom Boulevard, Suite 375
Sacramento, CA 95826
Dear Dr. Sullivan:
Dr. Patterson's letter regarding manipulation under anesthesia and Patient X's file was forwarded to our home office for review.
This file was reviewed by our medical and legal departments and by an independent chiropractic consultant. All agreed that charges for manipulation under anesthesia should be allowed for Patient X.
The chiropractic consultant commented that "this policy recommendation was made prior to the publication of the Guidelines for Chiropractic Quality Assurance and Practice Parameters, better known as the Mercy Guidelines. The Mercy Guidelines give MUA an equivocal rating... The prior recommendation and adoption by PM of classifying MUA as experimental, although correct at that time, is superseded by the classification assigned by the Mercy Guidelines.
Based on the chiropractic consultant's review, our medical and legal departments have agreed that Patient X's claims should be honored. Charges will be processed and benefits will be issued to Dr. S.
Enclosed please find a copy of the chiropractic consultant's review. If we may be of further service, please feel free to contact our office.
Sincerely,
Ginny Thomas
Senior Benefits Consultant