Maintenance Care Transition

Maintenance (or wellness) care is the goal for many chiropractic treatment plans. We all want to return patients to their preclinical state or better, and then we want the patient to continue receiving chiropractic care for preventative purposes. However, sometimes the maintenance transition can be lost along the course of care. Whether it’s a chronic condition that has reached maximum therapeutic benefit or a condition that resolved faster than the plan but might still be billing insurance, usually the general outcome in these cases is that the patient doesn’t know to look forward to maintenance care and when to expect that change.

Many patients are under the impression from their insurance company that they are entitled to their full, chiropractic coverage each benefit year regardless of condition status. Insurance plan summaries and even benefit details don’t contain enough information for the patient to explain that the chiropractic benefit is limited to clinical conditions set forth by the insurance policy. The patient’s neuromusculoskeletal condition must exhibit pain and/or lack of function that has the ability to resolve within a short period of time. If the condition goes beyond a month or so with very little to no improvement, then the insurance can consider future care not to be medically necessary

Insurance companies have even taken a step further to say not only will they not pay for non-medically necessary services but that they will also state the charges are not the patient’s responsibility on the explanation of benefits! EOBs often contradict the insurance policy itself because policies all state that maintenance care is not a covered service (hence patient responsibility). Do yourself a favor, and don’t get caught in the middle of trying to explain to patients the charges they owe and how the EOB states they owe nothing. As the doctor, draw the line when maintenance care begins and use the insurance’s clinical guidelines as parameters. If the patient questions your decision, you can always point to the insurance company’s policy that you followed in making this decision.

Even though it would be wonderful to have preventative chiropractic care part of the chiropractic insurance benefit someday, I’ve only seen ONE policy in all my career that includes it. In the meantime, educate your patients from the beginning and throughout their care on achieving a maintenance care status. Be very clear in your communication so the patient knows exactly what to expect. Clear communication prevents messy patient relations and awkward EOB moments- something I’ve seen too many times.

I've researched all major insurance policies and used their clinical guidelines to explain insurance coverage and maintenance care. Taking this into consideration is how I created my Chiropractic Maintenance Care Form for Patients.

The form naturally fits with a patient’s re-evaluation when the doctor and patient discuss continuing care, but it can be used at any time the doctor determines that care is maintenance. It’s important to have this understanding in writing because it can be easy to have a miscommunication or for the patient to forget about the conversation. Protect your practice, and use a maintenance care transition form.

As a reminder, all of my forms, worksheets and tutorials are emailed to you in digital format so you only pay once and can print unlimited copies for your practice (A LOT cheaper than the pre-printed kind).

Thank you for your continued effort in creating healthy communities.

Remember, consistency builds momentum, and momentum builds your practice.