Complete Story
05/13/2026
When Delay Becomes Denial: The Prior Authorization Crisis in Chiropractic Care
By Dr. Tim Munderloh DC FIACN | Member, AAC Reimbursement Fairness Committee
Not long ago, a patient came into my office with a chronic cervical complaint — the kind of case we see every day. The clinical path forward was clear. But before I could begin care, I had to navigate a prior authorization process that consumed hours of staff time, required repetitive documentation, and still produced a weeks-long delay. The patient’s condition worsened while we waited. This was not an exception. This is the system working as designed.
“Delay is not neutral. For our patients, delay is harm.”
Prior authorization was conceived as a utilization management tool to ensure clinical appropriateness before services are rendered. In practice, it has become a structural barrier. The American Medical Association has documented that 93% of physicians report that prior authorization delays patient care, and 89% say it contributes to clinician burnout. For patients with chronic neuromusculoskeletal conditions, those delays mean worsening pain, loss of function, and increased reliance on medications or more invasive procedures.
The reimbursement picture makes this worse. The OptumHealth/UHC Arizona chiropractic fee schedule — administered through a well known specialty TPA — sets a flat commercial per-visit fee of $55.00, covering everything from the evaluation to supplies. That rate has not meaningfully changed since at least 2016. Meanwhile, in late 2024, UnitedHealthcare expanded prior authorization requirements for chiropractic services across its Medicare Advantage plans. The administrative cost of obtaining authorization is rising as reimbursement stands still. When prior authorization overhead is factored against Medicare CMT rates of $25 to $37, the economics of treating these patients can become untenable — which may be precisely the point.
Electronic prior authorization infrastructure now exists across mainstream medicine, yet chiropractic specialty TPAs continue to rely on manual, non-standardized, and repetitive processes. Arizona chiropractors consistently report redundant documentation demands, delays that exceed reasonable clinical timelines, and opaque denial rationale that makes appeals nearly impossible. The CMS Interoperability and Prior Authorization Rule (CMS-0057-F, 2024) requires covered payers to implement electronic PA, meet defined decision timeframes, and publicly report authorization metrics. NCQA Utilization Management standards are equally clear: authorization processes must not create unnecessary barriers to clinically appropriate care. The regulatory floor is rising. The question is whether we demand that TPAs meet it.
The AAC Reimbursement Fairness Committee is actively engaged in regulatory analysis, data collection, and advocacy to hold payers accountable. But we need your participation. I am asking every Arizona chiropractor to stay engaged with committee updates, document your prior authorization experiences, and support efforts to modernize and enforce compliant authorization processes across the state.
Our patients should not have to wait for care that is already clinically justified.
Join us for the Reimbursement Fairness Committee Breakout Session at the AAC 2026 Convention on Sunday, June 14th at 8:00 AM to learn more about the challenges impacting our profession and the solutions we’re working toward together.
To find out more about how to get involved, contact Dr. Jeff Trinka at jefftinka@gmail.com
REFERENCES
- CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), January 2024. cms.gov
- NCQA Utilization Management Standards (UM 1–UM 4). ncqa.org
- AMA 2023 Prior Authorization Survey. ama-assn.org
- OptumHealth Care Solutions / UnitedHealthcare Arizona Chiropractic Fee Schedule, effective 6/1/2016.
- UnitedHealthcare Medicare Advantage Prior Authorization Requirements for Chiropractic Services, 2024. uhcprovider.com
