When you aren’t feeling well, you visit your primary care doctor. He or she is the expert when it comes to your overall health. Just like you’d trust Hermione Granger to give the correct answer in a classroom, Encyclopedia Brown to solve the latest neighborhood crime, or Siri to tell you what time it is, you trust your primary care doctor to tell you what’s wrong when something doesn’t feel right.
Primary care health physicians are specifically trained for and skilled in comprehensive health promotion, disease prevention, health maintenance, and the diagnosis and treatment of acute and chronic illnesses. They assess what’s going on and refer you out to a specialist, if and only if they feel it necessary. Specialists, like chiropractors for example, have designated areas of expertise. Chiropractors specialize in the diagnosing and locating of misaligned or displaced vertebra.
In North Carolina, a bill was filed that would “prohibit insurers from charging a higher copayment for chiropractic services than what is charged for a primary care physician for a comparable medically necessary treatment or condition.” Basically, the bill is trying to mandate that chiropractic visit copays be the same as primary care doctor copays.
The bill (SB 428) would also allow chiropractors to perform medical examinations for public school students participating in school athletic competitions. (Say what?!)
So, why should you care? We’re glad you asked.
The Problems With SB 428
To begin, medical examinations for school athletics are typically performed by a physician with an in-depth understanding of a person’s overall health system, but in several states chiropractors are granted extended “scopes of practice.” Some people argue that these extended scopes are outside of a chiropractor’s field of study, while others argue that a shortage of health professionals and a chiropractor’s degree are ample enough reason to allow this. SB 428 would grant chiropractors an extended scope of practice to perform exams typically done by primary care physicians.
As for the equal copay part, the bill would require insurance companies to treat chiropractors like primary care doctors. When it comes to your insurance, a chiropractor is considered a “specialist.” While a physician like a primary care doctor provides overall wellness and routine health checkups typically covered by your insurance plan, specialist visits (like dermatologists, podiatrists, and chiropractors) usually require a higher copay than primary care visits.
You might be thinking right now, “Well, this bill is great! Cheaper copays!”
But, not so fast.
Cheaper copays don’t necessarily mean less money coming out of your pocket. In fact, it could mean more.
Let’s break it down.
Somebody pays for that chiropractor visit. All that money you’re “saving” with a cheaper chiropractic copay is being shifted to the overall cost of everyone’s health insurance premium. That means everyone pays for chiropractic care, not just those who use it. Premiums would rise across the board. It’s just pure math. So, whether you use a chiropractor routinely or not, this bill affects YOU.
This brings up another point — why pay for something that you may not use? Most specialist visits require higher copays because they are just that — specialists, and patients typically don’t see specialists as often as primary care physicians. A study from 2016 revealed that 15% of U.S. adults, (an estimated 35.5 million people), had seen a chiropractor in the last year. This may seem like a lot, but over 290 million people were insured in 2015, meaning that only 12 percent of those with insurance plans actually used chiropractic services.
A similar law to SB 428 was enacted in 2005 and then repealed in 2007. North Carolina is the only state attempting to pass chiropractic copay laws, and has already done so and ultimately failed once before. Should it fail again?