Chiropractice Insurance Abuse in the 1960s

James P. Deely, health insurance director of the National Association of Letter Carriers, presented this report to the association’s officers and directors at its 45th national convention held August 14-20, 1996, in Detroit.

Our Actuaries opposed the inclusion of a “Chiropractor” in our definition of a “doctor” when the Plan was established in 1960. In an effort to make available as many practitioners as possible, we persuaded our professional consultants to accept our point of view. Chiropractic was recognized.

Almost from the inception of the program we encountered trouble with chiropractic claims. Expenses were submitted for X-rays that could not be interpreted, due to the poor technical quality of the films; claims were made for treatment of measles, mumps, heart trouble, mental retardation, female disorders and sundry other ailments. None of these conditions has any medical relationship to vertebral subluxations or spinal misalignments.

For the contract term beginning November 1, 1964, clarifying language relating to chiropractic was put in our brochure. The new language was not a change in benefits; it simply clarified the benefits allowable. Recognition of chiropractic was never intended to cover any expenses beyond spinal adjustments by hands of vertebral subluxations or misalignments. As is the case in all other types of claims, the Plan reserved the right to require x-rays to demonstrate the presence of the diagnosis.

In the interim, the problem became worse instead of better.

Early in December 1964, several other employee organizations suggested we join them in a meeting with the national officers of the two major Chiropractic groups. On December 8-9, 1964, we did participate in a conference with leaders of the American Chiropractic Association and the International Chiropractors Association. This meeting developed the interesting and significant fact that our problems with chiropractic were identical to those of the other participating plans.

After a frank and complete review of the situation, both associations issued bulletins to their respective membership. It is doubtful if anyone of the employee representatives could express the problem more clearly or succinctly than did the two chiropractic associations.

The bulletin of the American Chiropractic Association stated:

We were invited to the meeting to impress upon us the urgency and the need for adequate cost control to counteract the many claims abuses by members of our profession. We are amazed at the number of fantastic claims and cases which were shown to us to justify the urgency of the situation.

The International Chiropractors Association reported:

The leaders of both ACA and ICA made repeated efforts to impress upon their membership the gravity of the situation, and the need to halt and prevent further abuses of insurance benefits. For reasons I cannot explain, these efforts produced no discernible improvement.

By mid-1965, we were convinced that it would be a greater disservice to our member to continue recognition of chiropractors than to eliminate them from our contract. If recognition continued, and the abuses also continued, the inevitable result would be financial disaster for many of our members. That is to say, some chiropractors would continue to furnish treatment for services not covered under the contract which, in turn, would result in the member literally “holding the bag” for incurred expenses that were not insurable, although the chiropractor would have every right to expect payment from the patient.

In commenting on this subject, one fact should be emphasized. It is a matter of record that we not only engaged the professional services of disinterested medical consultants to interpret x-rays in dispute, but we also made the same x-rays (and related claim data) available to representatives of both chiropractic groups.

One incident will dramatize the problem confronting me as Director of our Plan. At our invitation, representatives of both ACA and ICA met in our office with one of the most reputable radiologists in the area, whom we had engaged on a temporary consultant basis. Our doctor (medical) presented 20 sets of X-rays that had been submitted by chiropractors. Each film was purported to show a subluxation; in several instances, four to six subluxations had been diagnosed in a single X-ray. One after another, each film was placed in the view box. The chiropractic representatives, including a radiologist of their own selection, were invited to point out the subluxations. Not a single one was identified. Nor did the chiropractic representatives offer a solitary comment.

Effective January 1, 1966, the brochure was amended to delete a “Chiropractor” in the Plan’s definition of a “doctor.