Iowa Doctors of Chiropractic Survey Regarding Patient HealthCare Coverage

Informed Consent to Participate in this Survey

Thank you for participating in this survey. Your feedback is important.

You are being invited to allow the researchers to use your survey responses as part of a scientific study aimed at advancing knowledge in health care insurance coverage in Iowa for chiropractic care.

The purpose of this study is to assess the perception of Iowa Chiropractors regarding coverage of chiropractic services by insurance companies. We will collect surveys from Iowa DC's who live or practice in Iowa only.

Your individual name and email is being collected but will not be used or published in any way. Geographic data, such as the county in which you reside, will be collected, and combined with others for analytical purposes. Your survey answers will remain Confidential and untraceable back to you after submission.

Participation in this study is entirely voluntary. You have the right to choose not to participate, and you may decide to stop responding at any point before submission. Once you have submitted your survey, withdrawing your responses will not be possible as they cannot be linked back to you. Data will be collected via Survey Monkey and stored by the researchers indefinitely. This study involves minimal risk to participants.

Your name will not be shared with anyone beyond the research team. This includes not sharing your name with legislators, trade organizations, professional organizations, etc. Your name will not be published. The reason for collecting your name is to prevent duplicate responses.

While you will not receive direct benefits or compensation for participating in this study, your responses may contribute to the improvement of care for others in the future. If you have any questions, please reach out to Dr. Tyler Steward at (715) 760-5536.

Thank you.
This survey should take about six minutes.

1.I have read and understood the informed consent information above and agree to participate in this survey.(Required.)

Yes

No

3.What is your gender?

Male

Female

Prefer to self-describe

Prefer not to say

4.What County do you primarily practice in in Iowa?(Required.)

5.Which of the following insurance practices has negatively affected your business? (Select all that apply.)(Required.)

Other (please specify)

6.How would you describe the reimbursement rates your practice receives from major insurance plans in your region?(Required.)

7.How much below your published fee schedule do insurance companies pay for your chiropractic evaluation and management services?(Required.)

8.How much below your published fee schedule do insurance companies pay for your x-ray services?(Required.)

9.How much below your published fee schedule do insurance companies pay for your chiropractic manipulation therapy services?(Required.)

10.How much below your published fee schedule do insurance companies pay for your physical rehabilitation and therapy services?(Required.)

11.Which of the following best describes your participation in insurance plans that have relatively low reimbursement rates?(Required.)

I choose not to participate in any plans with low reimbursement rates

I participate in some low-reimbursement-rate plans, but have limited my involvement because of reimbursement.

I participate in most or all low-reimbursement rate plans, despite lower reimbursement, because of patient demand or network access.

I do not consider reimbursement levels a significant factor when deciding plan participation.

Unsure / Not applicable

12.What is the main reason you continue to participate in insurance plans with lower reimbursement rates?(Required.)

The majority of patients in my area are covered under those plans.

Employer or regional contracts make these plans essential for maintaining patient volume.

I value being accessible to a broad patient base, even if reimbursement is low.

Administrative simplicity or other operational factors outweigh reimbursement concerns.

None of the above

Other (please specify)

13.How significantly have low reimbursement rates affected the financial sustainability of your practice?(Required.)

Very — profits or salaries are notably reduced.

Somewhat — margins are tighter but manageable.

Minimally — we’ve adjusted to compensate elsewhere.

Not at all — rates have not affected our operations.

Unsure / Not applicable

14.To what extent do you agree or disagree with the following statement: In your practice, office visit limitations or caps imposed by insurance companies reduce the quality of patient outcomes.(Required.)

15.To what extent have reimbursement amounts from insurance companies affected your clinic’s staffing levels and/or staff salaries?(Required.)

Very negative – staffing or pay has decreased noticeably.

Somewhat negative – minor reductions or hiring limitations.

Slightly negative – small adjustments but no major change.

Neutral – no effect on staffing or salaries.

Slightly positive – modest increases in staffing or compensation.

Somewhat positive – clear improvement but not substantial.

Very positive – major improvement in staffing or pay levels.

Not applicable

16.Have you ever been denied access to a preferred provider network or an Iowa HMO plan due to caps on providers or the HMO not accepting new applications?(Required.)

Yes

No

Unsure

Not applicable – I do not participate in networks

17.What level of agreement or disagreement do you have with the following statement: In your practice, insurance coverage restrictions on chiropractic care, such as pre-authorizations, make it harder for patients to receive the chiropractic care they need.(Required.)

18.What level of agreement or disagreement do you have with the following statement: In your practice, insurance reimbursement limitations make it harder for patients to continue recommended chiropractic care because of financial strain.(Required.)

19.Do you have patients who have chosen medical procedures over your recommended chiropractic care due to better insurance coverage for medical care?(Required.)

20.How satisfied are you with insurance coverage and reimbursement for patients receiving chiropractic services over the past 5 years?(Required.)

21.How would you rate the overall impact of insurance reimbursement limitations on your chiropractic practice? Check all that apply.(Required.)

Patient outcomes are negatively impacted due to coverage limitations

More stress on patients due to coverage limitations

Patients are less compliant with care plan recommendations due to coverage limitations

No impact – Do not accept insurance

Unsure

Other (please specify)

22.Estimate what proportion of your patients are affected by each of the following insurance limitations. Give a whole number as a percentage after each answer. Enter a number Zero to 100. (You may provide approximate percentages. Totals may exceed 100% because some patients experience more than one limitation.)(Required.)

Lower Reimbursement rates

Visit capitation limits

Increased paperwork

Pre-authorizations

Restrictions on patient access

Other

23.In the past 24 months, have any of your patients’ insurance coverage required pre-authorization before providing care for a second or additional office visit(s)?(Required.)

Yes

No

24.If yes to question #23, what type of effort or mechanism for pre-authorization was required?(Required.)

25.If yes to question #23, how long did the pre-authorization request take to complete?(Required.)

27.If yes to question #23, on average how many visits does the insurance company authorize on the first request for care? (If this varies by insurer, please estimate the most common or typical number.)(Required.)

28.What degree of agreement or disagreement do you have with the following statement: In your practice, insurance company denials for authorization of chiropractic care have reduced the quality of patient outcomes.(Required.)

30.How have insurance company restrictions on access to patients affected your practice?

31.Please enter your name and email(Required.)

First name:

Last name:

Email: