Re-examinations

Recently our office had a case where our client received chiropractic treatment following an auto accident. When it came time to make a claim against the auto insurance of the driver who caused the accident, the auto insurance questioned the last thirty chiropractic visits received by our client. This auto insurance, like most auto insurance companies, has a nurse on staff that helps determine the necessity and appropriateness of the treatment sought by those who make claims. This nurse went over the treating doctor’s records and determined that last 30 chiropractic visits were unnecessary, and the carrier did not want to pay for them.
It would be easy for us to argue that the nurse who saw these treatments as unnecessary is not qualified to make that decision. A jury or arbiter might even agree with this argument. More likely if it were to go to trial the insurance company would just hire and actual DC to say the same thing. However, a far superior argument would be the obvious objective improvement of the patient’s or claimant’s injuries during the last 30 visits. If it were clear that the condition objectively improved during that time period, it is likely that there would have been no question regarding necessity. The best way to show the objective progress of the patient is to perform and document a re-examination of the patient’s injuries. This way a nurse, adjuster, jury or arbiter can look at the re-examination and compare it with previous examinations to see the improvement in the patient’s condition. If no re-examination is performed there is a lack of objective evidence that the patient is benefiting from continued chiropractic care.
Unfortunately in the aforementioned case, a re-examination was not performed during the last thirty visits of chiropractic care, leaving us without our best argument in our efforts to get our client’s treatment paid for. Re-examine your patients, do it frequently and record the measurements and findings of those re-examinations. Too many DC’s rely on a SOAP Note with the word “improved” checked off to justify care. This is not good enough. The DC community must do better!