For most, health insurance plays a pivotal role in ensuring that individuals have access to essential medical services. But what about services that fall outside the traditional realm of medical care, such as chiropractic treatments? Let’s explore whether health insurance typically covers chiropractic care and what you need to know about accessing these services.
Understanding Chiropractic Care
Chiropractic care is a holistic approach to health that focuses on diagnosing and treating musculoskeletal conditions, particularly those related to the spine. Chiropractors use manual adjustments and various techniques to alleviate pain, improve mobility, and enhance overall well-being. Many individuals seek chiropractic care to address issues like back pain, neck pain, and headaches, and even to support their general health and wellness.
Learn more about chiropractic care…
Does Health Insurance Cover Chiropractic Care?
The coverage of chiropractic care varies depending on the type of health insurance plan you have. Here’s what you need to consider:
Types of Insurance Plans Covering Chiropractic
Health insurance plans can broadly be categorized into two types: HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). HMO plans usually require you to receive care from an in-network provider, while PPO plans offer more flexibility in choosing healthcare providers. Chiropractic care coverage may differ between these plan types.
In-Network vs. Out-of-Network Chiropractors
Many health insurance plans have a network of preferred providers. If you choose an in-network chiropractor, you are more likely to receive coverage for their services. Out-of-network chiropractors may still be covered to some extent, but you might incur higher out-of-pocket costs.
In the past few years, tiers have been implemented that further divide your chiropractors into groups based on their visit metrics. If the doctor typically recommends fewer visits, their copay tier may be significantly lower than ones who frequently recommend longer treatment plans.
Medical Necessity of Chiropractic Visits
Insurers typically cover chiropractic care when it is considered medically necessary. This means that your chiropractor’s diagnosis and treatment plan should align with your health insurance company’s guidelines. If the care is deemed not medically necessary, it might not be covered.
Maintenance care, supportive care, and palliative care are not medically necessary and will be denied once submitted. Retrospective reviews often find that treatment was not medically necessary after the visits have been completed, and in some circumstances years later.
Discovery of these types of visits almost always prompts an audit of your doctor’s office and can cause a repayment scenario.
Chiropractic Visit Limits
Health insurance plans often have visit limitations or a cap on the number of chiropractic visits covered in a given period. Be sure to understand your plan’s specific limits. Very often, insurance companies will use medical necessity guidelines to impose stricter visit limits.
Just because your plan offers 20 visits of chiropractic care, that doesn’t mean that the visits will be recognized as reasonable and necessary by the insurance carrier as the claim is being processed.
Pre-authorization of Chiropractic Treatment
Today, MOST insurance plans require pre-authorization before you can begin chiropractic treatment. Always check with your insurer to understand their requirements.
Some of these prior authorization requirements are carried out by third-party companies that manage chiropractic benefits specifically.
These programs can impose additional limitations and requirements that are hidden from the consumers and are often not well understood by the doctors themselves.
Deductibles and Co-pays
Even if your chiropractic care is covered, you may still be responsible for deductibles and co-pays, which are out-of-pocket expenses you need to pay before your insurance coverage kicks in. Co-pays are due at the time of service and collection by the providing office is required by law. Routinely waiving copays or deductibles is considered fraud and is a serious, federally-recognized offense.
How to Verify Your Chiropractic Care Coverage
To determine whether your health insurance covers chiropractic care, take the following steps:
- Contact Your Insurance Provider: Call the customer service number on the back of your insurance card or visit their website to check your policy details.
- Inquire About Network Chiropractors: Ask for a list of in-network chiropractors if you have an HMO plan.
- Understand Coverage and Costs: Clarify what services are covered, any limitations, and the associated costs.
- Get a Referral: If required by your plan, obtain a referral from your primary care physician.
Insurances That Cover Chiropractic Care
Click the insurance company below to learn more about their specific policies.
- Aetna (Now owned by CVS Health)
- Cigna
- United Healthcare
- Blue Cross Blue Shield
- Medicare
- UPMC Health Plan
Paying For Chiropractic Out Of Pocket May Save Your Money
If you have insurance AND your chiropractor has a contract with your insurance carrier, they are required to submit to your carrier and the rules are very strict. However, if your care is for services that are not covered OR if your chiropractor decided to become a self-pay practice, you may be able to save a significant amount of money on your care.
The unexpected and unbelievable reality is that insurance company guidelines often require you to have more chiropractic visits than are necessary. Even if your problems are resolved, not completing the required treatment plan can cause your entire care plan to be labeled “not medically necessary.” In recent years, some chiropractors have taken it upon themselves to remedy the scenario.
By canceling participation with insurance carriers, these chiropractors are allowed to offer lower fees and can recommend care on a per-visit basis. This means that there are no regulations imposing requirements or limits on your visits. The decisions are now strictly between you and your doctor. This can be a significant savings for you as a consumer. Each chiropractor will have their own fees and policies, so you will need to call each office you are considering to discuss their unique financial policies.
Chiropractic care can be a valuable component of your healthcare journey, especially if you’re seeking non-invasive, drug-free approaches to managing musculoskeletal issues. While health insurance coverage for chiropractic care varies, understanding your policy and taking the necessary steps can help you access the care you need. It’s essential to do your due diligence, ask the right questions, and explore your options to make informed decisions about chiropractic care within the scope of your health insurance plan.
Does Aetna Cover Chiropractic?
Does United Healthcare Cover Chiropractic?