Do you have health insurance? If you do and you need chiropractic treatments, the chances are good that your insurance will cover at least some of the chiropractic care you need.
Approximately 20 million Americans visit chiropractors ever year for help with a variety of issues. That according to the NCCIH, which also estimates that those people spend about $4 billion dollars a year for the care they receive.
That might seem like a lot of money, but it would be higher if many insurance policies didn’t cover chiropractic care.
Many insurance carriers will cover chiropractic visits when they are to help a patient with the treatment of a short-term condition or injury. However, they typically do not pay for long-term or maintenance care.
In this article, we’ll explain how insurance plans typically cover chiropractic treatments, why they don’t usually cover maintenance chiropractic care, other limitations that may apply, and what your options are if your health insurer won’t pay for chiropractic treatments.
How Insurers Cover Chiropractic Care
Most children and adults who have insurance coverage have a policy through their employer or a marketplace plan they acquired through the Affordable Care Act. Let’s talk about each of those options and how they may impact your coverage.
Workplace insurance plans often cover some chiropractic treatments under specific circumstances. It’s difficult to generalize since there are so many different plans in place. However, it’s typical for employer plans to cover chiropractic visits if they are:
- Medically necessary to treat an injury or condition
- Prescribed by a doctor (If an HMO plan)
It’s common for there to be other limitations, and we’ll talk about those in the next section.
If your insurance is a marketplace or off-market policy you bought through the Affordable Care Act, your plan may also cover chiropractic care, even though the ACA does not require plans to provide chiropractic coverage.
The ACA does require plans to cover 10 essential health benefits, and one of them is rehabilitative and habilitative services. In some plans, that includes treatment by a chiropractor. Some states require coverage of chiropractic care, while others include it in their so-called “benchmark” plan, which means it must be included.
What Are Some Common Limitations on Chiropractic Care?
While many insurance plans provide coverage for chiropractic care, they also impose some limitations on the kind of care and the amount of care an individual may receive. Here are some of the most common limitations:
- You must have a referral from your doctor for the care to be eligible (If an HMO plan)
- Your doctor and/or chiropractor must create and follow a detailed care plan
- You may be required to use in-network or approved chiropractors (if no out of network benefits)
- There may be a cap on how many times you can use a chiropractor per month or per policy year
It’s important to remember that insurance companies are focused on medical necessity. If your doctor recommends chiropractic care – and if they can make a compelling case that it’s an alternative to something more expensive – your insurance company is likely to cover it.
Why Don’t Insurance Carriers Cover Maintenance Chiropractic Care?
One of the most common questions people ask about insurance and chiropractic care is why their policy doesn’t cover routine care.
The primary reason is that insurance companies want to see steady improvement when they are paying for treatments. Visiting a chiropractor can help you avoid future problems, but the insurance model is geared toward fixing health issues, not preventing them.
Does that mean you should assume your policy won’t cover chiropractic? Absolutely not. If you’re not sure what’s covered, check your policy and then call to make sure you understand how much is covered and what’s not covered.
What Can I Do if My Plan Doesn’t Cover Chiropractic Care?
What happens if you check your policy and learn that your plan doesn’t cover chiropractic care at all?
That’s a question that some patients must deal with. Chiropractic visits can cost between $30 and $200 depending on the chiropractor’s location and the treatment needed.
Here are a few options to consider:
- Talk to your doctor to see if they can smooth things over with your insurance carrier
- Talk to the insurance company yourself to argue your case
- If you can afford it, buy a supplemental insurance policy that covers chiropractic care
- Talk to your chiropractor about a price reduction or payment plan
Chiropractors want to help their patients, and many are willing to work with patients whose insurance doesn’t cover the treatments they need.