Posted on May 8, 2011 by Medical Health Insurance Today

The American Chiropractic Association recently released details from an investigative report that looked into the practices of the Kentucky Office of Insurance for Humana. Evidence was presented that showed that the Humana office acted illegally in some cases that were related to chiropractic care as covered by Humana.

Chiropractors and medical health insurance providers have had trouble finding common ground in the over hundred years that chiropractic services have been moved into the mainstream. Chiropractors have long sought to be considered professionals in the medical field but insurance companies have been slow to comply with that agenda. Recently, over the past twenty or so years, chiropractic care has become the third largest profession after medical and dentistry. As more knowledge is spread, insurance companies have started to include these services, although it has taken quite a few lawsuits from both sides of the issue to make this happen.

A recent example of these legal actions is the aforementioned investigation into the Kentucky Humana office of insurance. The documents, which were released to the public, demonstrated that a number of violations of the consumer code of practice of the insurer were made. Humana, as a result of this investigation, was fined one-hundred thousand dollars and will have to change their policies. The American Chiropractic Association wants this action to be carried into other insurance departments and is calling for widespread sweeping changes that will change policies considered as discriminatory to chiropractic providers.

The American Chiropractic Association focused on Humana’s handling of chiropractic claims and violations. Some of the claims that were addressed were that chiropractic providers were subjected to reviews that were based in a discriminatory practice regarding the geographic location of the provider. On claims of chiropractic services, Humana included coding that was not correct, as well as the misrepresentation of negotiated reimbursement. Humana was also accused of conducting business with third party administrators that were unlicensed and not notifying plan members of that relationship. Humana was also accused of denying claims improperly, presenting misleading information in statement of benefits and failing to notify the Kentucky Office of Insurance about their review process and changes in procedure.

The president of the American Chiropractic Association was said that “the ground gained by the …profession after standing firm and unrelenting… is a wonderful example of what we can achieve when we work together…”. The American Chiropractic Association is currently working on other cases in other states where issues similar to these related to Humana have been filed as complaints.

These types of investigations into practices of insurance companies, especially those that border on illegal or discriminatory towards chiropractic care, are little steps towards the fair treatment of the profession by insurance companies. As more investigations continue and more is uncovered, it will slowly take chiropractic services towards being considered a full-fledged medical service by doctors and insurance companies. This attitude is already shared by millions of Americans and the insurance companies have been dragging their feet to make it happen any faster. This will drastically change the policies that insurance companies have on chiropractic service.