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Aetna's Clinical Bulletin on Chiropractic Care

According to U.S. News & World Report’s list of “Top Health Insurance Companies,” Aetna ranks fourth on the list. While the list is called “Top Health Insurance Companies,” the list focuses on percentage of market share, meaning that the fourth highest amount of Americans have some sort of plan with Aetna.

The insurance plans that Aetna provides are highly regarded by many within the medical community as well as in the consumer affairs community. An inside look into Aetna’s policy with respect to chiropractic care coverage could prove to be quite insightful in understanding the general outlook that health insurance companies maintain when it comes to chiropractic care.

In a quick overview of Aetna’s “Clinical Policy Bulletin: Chiropractic Services” a wealth of information is provided that could give us an idea of where chiropractic care stands in terms of value and importance to a major insurance provider. What immediately stood out was the criteria that needed to be met to in order to classify chiropractic care as medically necessary; the presence of a neuromuscular disorder, the medical necessity for treatment is clearly documented, and the documentation of improvement within the first two weeks of care delivery.

If improvement is not documented within the first two weeks, the chiropractic care pathway must be adjusted for it to still be covered. If there is no documented improvement within 30 days of the onset of chiropractic care, Aetna deems chiropractic care not medically necessary and will terminate coverage.

The next most intriguing feature of the clinical bulletin was the long list of procedures and diagnostic techniques that Aetna considers experimental and investigational. There are 29 procedures and 6 different diagnostic techniques that are acknowledged by Aetna to provide treatment to 16 different conditions recognized. There is an extensive body of literature that composes the clinical bulletin’s reference materials and as a massive corporation, Aetna has gone to great lengths to ensure that their insurance processes are adequate and fair but that are also cost-effective and profitable for the company.

The final section refers to the ICD-9 and ICD-10 codes of the conditions covered for physician analysis and administrative bodies. This report can be extremely useful for anyone considering a potential plan with Aetna that is also in search of coverage for chiropractic care. Many other popular insurance companies have similar documents and information regarding chiropractic care is usually provided by the company after some research.

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Used under Creative Commons Licensing courtesy of Sohel Parvez Haque

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