Is Chiropractic Care Covered?
Yes.
Blue Cross and Blue Shield (BCBS) typically covers chiropractic care as part of their health insurance plans. Coverage can vary depending on the specific plan you have and the state you live in. Chiropractic care is often included under BCBS’s policies as a way to manage and treat conditions related to the musculoskeletal system, especially back pain, neck pain, and other joint issues.
Chiropractic policies vary by state.
Chiropractic coverage criteria are as follows:
- Medical necessity guidelines must be met.
- Care must not be Maintenance, Wellness, or Supportive in nature.
- See the coverage guidelines for your specific state. Find the policy guidelines for the Blue Cross Blue Shield plan in your state here.
Does Chiropractic Care Need Pre-Authorization?
Yes, In most states.
Some Blue Cross plans require chiropractors to submit prior authorization requests to a third-party management company and to follow a Physical Medicine Management Program. This requires regular submission of documents and can add an extra administrative burden for the provider.
Additional benefit limits often are added and patients are required to undergo frequent reexaminations to determine progress and necessity for further care.
The providers are also tiered based on their compliance and use profiles. Providers who recommend less visits are rewarded with less administrative work and lower copays for their patients.
Is A Third-Party Used To Manage Chiropractic Benefits?
Yes, In most states.
Blue Cross 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, there are typically limits to chiropractic coverage under Blue Cross and Blue Shield plans. These limits can include:
Provider Network: Coverage is generally more comprehensive when using in-network chiropractors. Out-of-network care may result in higher out-of-pocket costs or reduced reimbursement rates.
Number of Visits: Many plans cap the number of chiropractic visits covered per year.
Medical Necessity: Coverage is often contingent on the treatment being medically necessary and appropriately documented.
Out-of-Pocket Costs: You may be responsible for copayments, coinsurance, or meeting a deductible before coverage applies.