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.
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.
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.
Insurances That Cover Chiropractic Care
Click the insurance company below to learn more about their specific policies.
Aetna | Aetna (now CVS Health) has a mixed history with chiropractic care, offering coverage for treatments that align with evidence-based practices while maintaining strict guidelines and limits on visits or services. While many policyholders appreciate the inclusion of chiropractic in their plans, others find the restrictions frustrating. This page explores Aetna’s chiropractic coverage, highlighting both its benefits and limitations to help you make informed decisions. Learn more…
AmeriHealth | AmeriHealth includes chiropractic services in its coverage, particularly for members under 21, as part of their physical therapy benefits. However, for members over 21, chiropractic care may not be covered unless it’s related to the treatment of specific conditions like an incomplete or partial dislocation of a spinal joint. This selective approach has been beneficial for some members but has also led to limitations in access for others.
Anthem (now Elevance Health) | Formerly known as Anthem, Inc., Elevance Health operates various health plans, including those under the Blue Cross Blue Shield brand. Coverage for chiropractic services under Elevance Health’s plans varies by state and specific policy, with some plans offering comprehensive chiropractic benefits and others providing limited or no coverage. This variability can lead to confusion among members seeking chiropractic care.
Blue Cross Blue Shield | Blue Cross Blue Shield (BCBS) has historically included chiropractic services in its health plans, recognizing their role in managing musculoskeletal conditions. Coverage specifics, such as visit limits and referral requirements, vary by state and individual policy. For instance, BCBS of Minnesota covers chiropractic care as part of an active treatment plan, while other state plans may have different provisions. Patients often appreciate the inclusion of chiropractic services; however, navigating varying coverage details can be challenging. Learn more…
Blue Cross Blue Shield of Michigan | BCBS of Michigan offers chiropractic care as part of its comprehensive health insurance plans. While coverage supports musculoskeletal health, limitations such as visit caps, documentation requirements, and pre-authorization can restrict access to ongoing care. This page details their chiropractic policies.
Centene Corporation | Centene Corporation, through its subsidiaries like Health Net, offers chiropractic coverage in certain plans, often in collaboration with entities such as American Specialty Health Plans. While this partnership provides access to chiropractic care, coverage specifics—including visit limits and the necessity for prior authorization—vary by plan and state, which can create inconsistencies in patient access.
California Physicians’ Service (Blue Shield of California) | Blue Shield of California offers chiropractic care coverage in many of its plans, making it accessible for those seeking non-invasive treatment options. However, limitations such as visit caps, prior authorization, and exclusions for maintenance care can restrict access. Explore Blue Shield of California’s chiropractic policies here.
CareSource | CareSource provides chiropractic coverage primarily through its Medicaid and Medicare Advantage plans. Although beneficial for many patients, coverage often includes strict criteria, visit limits, and narrow networks, which can complicate access. Learn more about CareSource’s chiropractic policies here.
Cigna | Cigna has a mixed history with chiropractic care, offering coverage for medically necessary treatments while maintaining strict guidelines and limitations. On the positive side, Cigna recognizes chiropractic care as a valuable option for addressing musculoskeletal issues and often includes it in its plans. However, coverage is typically restricted by visit limits, pre-authorization requirements, and the need for medical necessity documentation. These policies can create challenges for patients seeking consistent or preventative care. This page explores the nuances of Cigna’s chiropractic coverage to help you navigate your options effectively.
EmblemHealth | EmblemHealth includes chiropractic coverage in many plans, recognizing its importance for musculoskeletal health. However, limitations like visit caps, medical necessity requirements, and pre-authorization can make access to care challenging. Explore EmblemHealth’s chiropractic policies here.
GuideWell Mutual Holding (Florida Blue) | Florida Blue, under GuideWell Mutual Holding, includes chiropractic care in many plans, recognizing its value for pain management and musculoskeletal issues. However, coverage often comes with restrictions like visit caps, referrals, and medical necessity requirements, which may limit access for some members. This page explains Florida Blue’s chiropractic coverage.
Health Care Service Corporation (HCSC) | HCSC, the parent company of several Blue Cross and Blue Shield plans, offers chiropractic care coverage as part of its health services portfolio. While this inclusion highlights its recognition of chiropractic benefits, coverage can vary significantly by state and plan, often requiring pre-authorization and limiting visits. Learn more about HCSC’s chiropractic policies here.
Highmark Group | Highmark Health supports chiropractic care as a part of its broader commitment to musculoskeletal health, offering coverage in many plans for medically necessary treatments. However, policies often include visit limits, documentation requirements, and restrictions on maintenance or preventative care, which can limit access for some patients. This page explores Highmark’s chiropractic coverage to help you understand its strengths and limitations.
Humana | Humana offers chiropractic coverage, particularly through its Medicare Advantage plans, which may cover services like spinal manipulation when deemed medically necessary. However, coverage specifics can vary, with some plans requiring prior authorization and limiting the number of covered visits. While many members value access to chiropractic care, understanding the nuances of Humana’s policies is essential to fully utilize these benefits. Learn more…
Independence Health Group | Independence Health Group offers chiropractic care as part of its comprehensive health insurance plans, particularly through its Blue Cross Blue Shield affiliate. While coverage is available, restrictions such as visit limits, pre-authorization, and strict medical necessity criteria can create barriers for ongoing care. Learn more about their chiropractic coverage here.
Kaiser Permanente | Kaiser Permanente has a cautious approach to chiropractic care, reflecting both its strengths and limitations. While Kaiser acknowledges the benefits of chiropractic for musculoskeletal health, coverage is often minimal or excluded, depending on the region and plan. In some cases, chiropractic services are only available through affiliated providers or as an out-of-pocket expense. This selective coverage has drawn both praise for its focus on integrated care and criticism for limiting patient access. This page provides an overview of Kaiser Permanente’s chiropractic policies to help you understand your options.
Medical Mutual of Ohio | Medical Mutual of Ohio offers chiropractic coverage as part of its health insurance plans, supporting evidence-based treatments for musculoskeletal issues. Despite this, restrictions such as visit caps, referrals, and strict documentation requirements can limit access for ongoing care. Learn more about their chiropractic coverage here.
Metropolitan Group | The Metropolitan Group’s chiropractic coverage is typically part of its employer-sponsored health plans. While it includes medically necessary care, visit limits and strict pre-authorization requirements can be barriers for some patients. Learn about their chiropractic coverage here.
Molina Healthcare | Molina Healthcare includes chiropractic care in many of its plans, particularly for Medicaid and Medicare recipients. However, access can be restricted by limited networks, pre-authorization requirements, and tight coverage caps, making it difficult for patients to get consistent care. This page reviews Molina’s chiropractic policies and what you should know before seeking treatment.
UnitedHealth Group | UnitedHealthcare has a balanced but controlled approach to chiropractic care, offering coverage for medically necessary treatments as part of its commitment to comprehensive healthcare. On the positive side, UnitedHealthcare includes chiropractic services in many plans, recognizing their value in addressing musculoskeletal conditions. However, coverage often comes with limitations such as visit caps, pre-authorization requirements, and strict documentation of medical necessity. These restrictions can make accessing care challenging for some patients. This page outlines UnitedHealthcare’s chiropractic coverage to help you navigate their policies effectively.
WellCare Health Plans | WellCare offers limited chiropractic coverage, primarily under its Medicare Advantage plans, for medically necessary treatments. While this inclusion is beneficial, coverage is often constrained by visit caps and narrow networks, which can hinder access to care. Discover WellCare’s chiropractic policies here.