The Patient Protection and Affordable Care Act, commonly referred to as Obamacare, was officially enacted into law in March 2010. However, with open enrollment now underway (10/1/13-3/31/14) it is wise to gain an understanding of what this Act means for you as a chiropractor and the potential benefits and drawbacks it will have for your patients.

There are three main areas of the Act that affect chiropractic specifically:

(1)  Section 2706 of the Act states that insurers “shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable state law.” What does this really mean? Basically, under the Act, insurers are not allowed to discriminate against chiropractors when defining their standards for provider enrollment or reimbursement.

However, it does not require that they consider chiropractic services of the same or similar reimbursable value as other medical services. On the surface, some may view this provision as less than a step forward, with chiropractors once again ending up at the low end of the reimbursement rate spectrum for medical services.

However, digging a bit deeper you can see that this section of the Act also allows patients to select chiropractors as their primary care physician within their health plan. This step forward opens the door to furthering the spread of chiropractic and overall preventative/wellness care.

(2)  Section 3502 of the Act allows for the creation of “health teams”. These teams are to consist of interdisciplinary providers, including chiropractic, that work together to provide primary care to eligible patients.

There are some state-specific restrictions and requirements under this provision, but again, the inclusion of chiropractic to health teams will again further the spread of chiropractic and the manner in which alternative/holistic medicine is viewed overall by the public.

(3) Under the terms of the Patient Protection and Affordable Care Act, all new health plans are required to provide “essential health benefits” as a minimum level of care. However, each state is given the freedom to define what “essential health benefits” consist of.

For example, states like Washington consider chiropractic care as an essential service and therefore all new state health plans are required to cover chiropractic care to some degree. There are other states like California and Oregon that do not currently consider chiropractic as essential.

As a result, their state plans are not required to cover chiropractic services, leaving patients with the responsibility to cover services out of pocket.

Clearly, it is critical to understand the unique aspects of your individual state plans under the Act in order to fully grasp how it will affect your practice. However, these three areas offer a good starting point and will guide future conversations with your patients.

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About the author

Todd Crabtree

Todd Crabtree

Founder & Chief Technology Officer. Founded Clinic Doctor Inc. in 2004, to innovate the providing of insurance billing services to healthcare providers in chiropractic clinics that lacked the resources to pay for qualified billing professionals.

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