Dear Editor:

It is time someone took a stand against the IPAs and chiropractic networks that are started and run by chiropractors, hired to manage the chiropractic benefit of an insurer, and then underpay and administratively overburden the empanelled DCs. These networks are usually for-profit entities that underbid the contracts to establish a relationship with an insurer.

For example, if an insurer is currently paying $1 per member per month for chiropractic services, the network will come to the insurer and offer to manage the chiropractic benefit for only $.50 per member per month. The network then cuts reimbursements and arbitrarily sets visit limits, usually by finding most care after 3-4 visits "not medically necessary" and making the treating DC's paperwork and appeal processes overly burdensome so they cannot find time to comply with those processes.

Chiropractors are signing these network contracts for one of three reasons: They are just ignorant and do not know what they are signing; they are afraid to lose patients; or they undervalue their own services and sign the contract in order to participate with the network.

We need to take a stand against networks that treat their colleagues this way. These networks need to be exposed as harmful to the profession. DCs need to know that signing participation agreements with these networks not only affects that one insurer, but also reinforces the network's ability to gain more market share; after all, other insurers will no longer want to pay $1 per member, per month once they see it can be done more cheaply. Who cares if that cheaper option is at the expense of the chiropractic panel?

This topic is hot in the sense that we, the chiropractors in the field, are living this every day and our practices are suffering financially as the networks continue to reduce reimbursements to insufferable levels. (How about $30.53 maximum allowed office visit charge no matter what services you perform - and you cannot balance bill the patient? That's $30.53 for a new-patient consultation and exam and treatment, $30.53 for a re-exam of an existing patient with a new injury and diagnosis, and $30.53 no matter what therapies or counseling you provide during a visit.)

The DCs who started and run these networks are the people responsible for these god-awful contracts that are being offered to members of their own profession. Somehow, we need to stop this practice of DCs eating their own for self-profit. Let's get this information out to the profession and begin the process of reclaiming our dignity and ostracizing chiropractors who would treat their fellow doctors so disrespectfully.

Leslie W. Lange, DC
Rochester, N.Y.

Dynamic Chiropractic encourages letters to the editor to discuss any issue relevant to the profession, including response to articles that appeared in a previous issue of the publication. All letters should be e-mailed to "> with "Letter to the Editor" in the subject field. Submission represents acknowledgement that your letter may appear in a future issue of DC, but does not guarantee publication. We receive considerable correspondence and endeavor to publish as many perspectives as possible.