Is Chiropractic Care Covered?
Yes.
AmeriHealth covers chiropractic services when specific medical necessity criteria are met. According to AmeriHealth’s medical policy, chiropractic spinal and extraspinal manipulation therapy is considered medically necessary when:
- The individual has a neuromusculoskeletal condition, and the available published literature supports the use of manipulation in treating the condition.
- The manipulation is performed within the scope of practice by an eligible professional provider.
If no improvement is documented within the first two weeks of treatment, the chiropractic treatment should be modified and performed for another two-week course. If there is no documented improvement after four weeks of treatment, even with modifications, additional treatment is considered not medically necessary and, therefore, not covered.
Does Chiropractic Care Need Pre-Authorization?
Yes.
AmeriHealth may require prior authorization for chiropractic services. Providers should consult AmeriHealth’s policies and guidelines to determine the specific requirements for pre-authorization.
Do I Need a Referral from My PCP?
It Depends.
The necessity of a referral from your primary care physician (PCP) varies based on your specific AmeriHealth plan. Some plans may allow self-referral to chiropractors, while others might require a referral. It’s essential to review your plan details or contact AmeriHealth directly to understand your coverage.
Is a Third Party Used to Manage Chiropractic Benefits?
It Depends.
AmeriHealth’s management of chiropractic benefits may involve third-party administrators, depending on the plan and region. Providers should verify with AmeriHealth regarding any third-party involvement in administering chiropractic benefits.
Are There Limits to Chiropractic Coverage?
Yes.
Chiropractic care is not covered if:
- No improvement is documented within the initial treatment period.
- The patient is asymptomatic.
- The care is classified as maintenance therapy, which is considered not medically necessary and, therefore, not covered.
How Do I Find an AmeriHealth Chiropractor?
To locate a chiropractor covered by AmeriHealth:
- Contact AmeriHealth Directly: Use AmeriHealth’s provider directory or contact customer service to find in-network chiropractors in your area.
- Inquire with the Provider: Reach out to chiropractic offices directly to confirm if they accept AmeriHealth insurance.
For the most accurate and personalized information, always refer to your specific plan details or contact AmeriHealth customer service.ways contact AmeriHealth customer service to get accurate and detailed information about your plan.