Is Chiropractic Care Covered?
Yes.
Chiropractic care is covered when all of the medical necessity criteria are met as outlined in the Aetna Policy Guide.
Chiropractic coverage criteria are as follows:
- The member must have a neuromusculoskeletal disorder that fits within the approved diagnosis list for chiropractors; AND
- The rationale for treatment must be clearly documented and medical necessity demonstrated by the provider; AND
- Improvement is documented within the first 2 weeks of care.
Does Chiropractic Care Need Pre-Authorization?
Yes.
Aetna requires chiropractors to submit prior authorization requests to a third-party management company. This requires regular submission of documents and can add an extra administrative burden for the provider.
Do I need A referral From My PCP?
No.
Typically a chiropractor is a “portal of entry provider.” This means that you can self-refer directly to the chiropractor of your choosing, without a referral from your doctor. This is not always true if you have an HMO. Specific plans may impose additional restrictions, so it’s always best to call your insurance carrier and have them explain your coverage thoroughly.
Is A Third-Party Used To Manage Chiropractic Benefits?
Yes.
Aetna requires providers to use a third-party management company that administers the benefits. Providers must submit documentation and have it reviewed by this company. Benefits may be further limited by the rules and regulations set forth by these outside management organizations.
The third-party benefits manager may vary by state. Provider’s offices are aware of these procedures and can inform you if additional limitations apply.
Are There Limits To Chiropractic Coverage?
Yes.
Chiropractic care is NOT COVERED if:
- Your condition has not improved in 2 weeks of care; no additional visits will be covered.
- You are asymptomatic.
- Your care is deemed Maintenance, Wellness, or Supportive.
- Your condition is non-musculoskeletal in origin.
Non-covered conditions include:
- Attention-deficit hyperactivity disorder (ADD/ADHD)
- Asthma
- Autism spectrum disorder
- Depression
- Dizziness/vertigo
- Dysmenorrhea
- Epilepsy
- Female infertility
- Gastro-intestinal disorders
- Improvement of brain function
- Menopause-associated vasomotor symptoms
- Prevention of falls
- Treatment of post-concussion syndrome
View Aetna’s Chiropractic Policies Here…
How Do I Find An Aetna Chiropractor?
You can simply call the provider’s office and the front desk associate will know the answer. This is probably the most common question they get throughout the day.
If you would like to contact your insurance company on your own, each has a provider directory and can provide you with a list of doctors in your area.