Denial of Re-Exams or Established Patient Care

Denial of Re-Exams or Established Patient Care

Many Chiropractic Physicians across Missouri have been contacting the MCPA about insurance companies denying re-exams or established patient exams. The MCPA Insurance Committee met with Anthem last week to discuss the issue.

If your exams are denied, we recommend sending in your records to the insurance company to prove that a separate and identifiable service was performed. The insurance companies are reviewing these records and paying on them after the records are sent showing that the service was done.

Anthem indicated the possibility of doctors not having to keep sending in records if we develop a track record of showing that we did indeed perform the established E&M. However, this is not official at this time and just an idea that they are considering.

Action Steps:

  1. Send records to prove the service is separate from the manipulation
  2. If you are denied even after sending the records, please contact the MCPA Insurance Committee through the MCPA Insurance Forum on the MCPA Member Only website so that we can continue a dialogue with the carrier showing additional examples.


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