The Best of Times, the Worst of Times (Pt. 1)

This article, drawing inspiration from Charles Dickens, captures the current, paradoxical state of the chiropractic profession: recognized by high-quality research and clinical guidelines as a first-line option for spinal disorders, yet undermined by administrative and financial challenges. The authors assert that reliance on new guidelines or research alone is insufficient; systemic changes to payment and network participation are required to ensure sustainable access to care. The discussion focuses on two powerful, often unseen, forces shaping the practice environment. First, the Medical Loss Ratio (MLR) loophole allows health insurance companies to transfer premium dollars via capitation to unregulated healthcare services businesses—like intermediary DC networks—which are then free to impose aggressively low fee schedules and administrative barriers such as prior authorization, emphasizing profit over quality patient care. Second, Mental Health Parity (MH parity) laws, which mandate equal treatment limits between mental health and medical/surgical benefits, inadvertently harm DCs. Because chiropractic care is often low-cost and involves frequent visits, it is frequently used as the comparable medical service, meaning the restrictions designed to manage high mental health costs are applied to chiropractic care, thereby limiting patient access and DCs’ economic viability.