4164 UHC Up to Its Old Tricks With Latest Headache Policy
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Dynamic Chiropractic – September 1, 2018, Vol. 36, Issue 09

UHC Up to Its Old Tricks With Latest Headache Policy

By Editorial Staff

A decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven and ineligible for reimbursement. The American Chiropractic Association and numerous other chiropractic organizations united in opposition to the policy,1 and UHC ultimately reversed course:2

In September of 2007 UnitedHealthcare issued a revised medical policy on Chiropractic Services. This policy stated that spinal manipulative treatment for headaches and for pediatric patients was unproven and therefore not a covered service. As announced in October [2007], the ACN Group Chiropractic Professional Advisory Committee (CPAC) has facilitated the collection of input from the chiropractic professional community regarding this revised policy. As a result of this interaction, UnitedHealthcare will not proceed with the chiropractic services policy change announced in the September 2007 UnitedHealthcare Network Bulletin.

Fast forward to a few months ago and UHC was up to its old tricks again, updating its policy on manipulative therapy to state that manipulation is "unproven and/or not medically necessary" for headache. Just like a decade ago, the ACA and others intervened, with the ACA sending a research-supported letter, cosigned by nearly 40 state and national chiropractic organizations as of press time, challenging the policy.3 And once again, UHC appears to have backtracked quickly by removing the language from its policy.

In the July 23, 2018 letter to UHC President / CEO Dan Schumacher, Dr. N. Ray Tuck Jr., president of the ACA, stated (excerpted): "Given insufficient and inadequate pharmacological management of migraine and cervicogenic headache, in particular, providing headache sufferers with viable alternatives for managing their condition is an important aspect of patient-centered care. This is why we were astounded to learn that a recently adopted UHC policy would deny coverage of chiropractic spinal manipulative therapy (SMT) for headache to thousands of affected patients by defining manipulative therapy as applied to the treatment of headache as 'unproven and/or not medically necessary.'"

"If UHC refuses to withdraw this policy, we plan to provide this information to our members so they may assist their patients in challenging your flawed guideline under ERISA appeals procedures (29 CFR 2560.503-1). We will also notify employers and other stakeholders that your guideline is flawed, does not reflect the most recent outcomes research, and improperly denies essential chiropractic care for headache pain. In addition, we will alert them as to how the use of this flawed policy, as a basis for adverse coverage determinations, may violate plan-governing documents in contravention of fiduciary responsibility."

As of press time, a boxed section at the bottom of the UHC policy on manipulative therapy4 titled "Policy History / Revision Information" suggests the headache restriction has been removed from the policy [our emphasis in italics]:

Revised coverage rationale:

Replaced language indicating manipulative therapy is unproven and/or not medically necessary for:

  • "Treating non-musculoskeletal disorders, including but not limited to lungs (e.g., asthma), internal organs (e.g., intestinal), neurological (e.g., headaches), and ear, nose, and throat (e.g., otitis media)" with "treating non-musculoskeletal disorders (e.g., asthma, otitis media, infantile colic, etc.) and internal organ disorders (e.g., gallbladder, spleen, intestinal, kidney, or lung disorders)"

The ACA took a cautious tone when commenting on the apparent policy reversal, stating: "The American Chiropractic Association (ACA) is aware that the UnitedHealthcare policy on manipulative therapy posted online has reverted back to its previous version. Talks between ACA and UHC regarding the headache policy continue." Stay tuned.

References

  1. Vivo M. "Profession Unites to Oppose UHC Policy." Dynamic Chiropractic, Nov. 19, 2007.
  2. "UHC Rescinds Policy Regarding Chiropractic Reimbursement: Treatment of Pediatric, Headache Patients Remains a Covered Service." Dynamic Chiropractic, March 11, 2008.
  3. ACA letter to UnitedHealthcare regarding UHC Commercial Medical Policy #2018TO5411 Manipulative Therapy / Non-Coverage for Headache, July 23, 2018.
  4. UnitedHealthcare Policy# 2018T0541J: Manipulative Therapy. Effective Aug. 1, 2018.

Dynamic Chiropractic editorial staff members research, investigate and write articles for the publication on an ongoing basis. To contact the Editorial Department or submit an article of your own for consideration, email .

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