Humana’s Clinical Policy Guidelines for Chiropractic Services
Is Chiropractic Care Covered?
Yes. Coverage details for chiropractic care vary based on the specific Humana plan and state regulations. Many Humana plans provide coverage for chiropractic services, typically when treatment is deemed medically necessary to address musculoskeletal issues such as back or neck pain. However, coverage limits and allowances can differ depending on the type of Humana plan, such as HMO, PPO, or Medicare Advantage, as well as the state in which the policy is issued.
Does Chiropractic Care Need Pre-Authorization?
Yes. Pre-authorization requirements depend on your location and specific Humana plan.
For example, some Humana plans require pre-authorization before chiropractic treatment can be approved. Chiropractors may need to submit documentation supporting the medical necessity of care, which Humana reviews to determine eligibility. In some cases, failure to obtain pre-authorization may result in denied claims or reduced coverage for patients, so it is essential to check with Humana or your provider before beginning treatment.
Is a Third-Party Company Used to Manage Chiropractic Benefits?
Yes, in certain cases.
Humana may partner with third-party companies, such as American Specialty Health (ASH) or eviCore, to manage chiropractic benefits. These organizations assist in administering pre-authorization processes, utilization management, and provider performance assessments to ensure compliance with Humana’s clinical guidelines.
Are There Limits to Chiropractic Coverage?
Yes.
Limits are often based on medical necessity guidelines. Many Humana plans impose an annual cap on the number of chiropractic visits covered or restrict coverage based on the type of chiropractic treatment received. Plans with utilization management protocols, such as those managed through third-party administrators, may have more stringent visit limitations and guidelines for care frequency.