Does Health Insurance Cover the Chiropractor?

Those suffering from persistent back and joint pain know the relief chiropractor care may provide. In the United States, chiropractic care involves everything from spinal adjustments and lower back pain relief to massage techniques and physical therapy.

Chiropractic care is also wildly popular in America. According to the American Chiropractic Association, more than 35 million Americans, including children and adults, are treated by chiropractors each year. There are over 70,000 chiropractors active in the United States today that must pass four national exams and be licensed by the state they practice in.

With the consistent popularity of chiropractors in the U.S., an important question remains: Does health insurance cover the chiropractor? Let’s take a look.

Health Insurance and Chiropractic Care

With so many different types and levels of health insurance in America figuring out the answer to the question, “Does health insurance cover the chiropractor?” can be tricky and sometimes confusing.

The short answer is it depends. Many of the major health insurance providers and health insurance offered by employers will cover chiropractic care in some form, especially if it is deemed medically necessary. For example, if you suffer from an injury that impacts your back or spine, like a fall or a car accident, and a primary care doctor refers you to a chiropractor, your health insurance will likely cover that referred care.

For those still wondering if health insurance covers the chiropractor, it’s always best to review your own health insurance thoroughly or give your health insurance company a call to discuss their chiropractic care policy in depth. They realize that health and wellness are important. If you participate in a health insurance plan offered by your employer, health care representatives tied to the company are often available to answer specific questions via email, over the phone, or through a face-to-face meeting.

Back Pain and Neck Pain

Most of the common medical practices chiropractors offer are covered by insurance, including spinal adjustments, which are focused on relieving pressure on your nerves. The same goes for chiropractic work on the lower back or neck. These usually address issues such as sciatica and nerve pain that travels from the spine down through the leg.

X-rays are often a part of chiropractic care, used to help determine specific beneficial treatments for patients and to get a complete understanding of the depth of the medical issue.

Health insurance most likely covers a chiropractic visit if you’re seeing them to address neck and back pain following surgery or a serious injury, or if you suffer from long-term, acute pain in the back or neck and your mobility is impacted.

Chiropractic Visits for Long-Term Care

While most health plans will cover at least some of your chiropractor’s costs, there are some exceptions that vary from plan to plan. You may be surprised when health insurance doesn’t cover most if not all of your bills.

In general, your health insurance may not pay for care that’s determined to be maintenance care or long-term care. What does this mean? Long-term care is when you see a chiropractor over a period of time for specific treatments, versus short-term care that is recommended to treat a recent injury.

Additionally, some insurance plans consider chiropractic care to be a form of alternative medicine. Most health insurance plans don’t cover such forms of medical care. Also known as complementary medicine or integrative health, alternative medicine refers to any form of care that’s considered non-conventional, such as naturopathy, acupuncture, or massage.

Since chiropractic care can integrate such forms of “non-conventional” medicine, health insurance may not help cover certain visits. It all depends on the type of care you seek and receive from your chiropractor.

Health Insurance Providers and Chiropractic Care

When determining if health insurance covers the chiropractor, it helps to see how some of the major health insurance providers compare. Medicare and workers’ compensation plans cover the majority of chiropractic care, but what about other popular plans?

Usually, you will need a referral from a primary care doctor, and there will be a limit to how many times you can receive chiropractic treatment within a set period of time and still have it covered. You may also need to see chiropractors in your health insurance network and those who will follow a care plan from your primary care doctor.

Additionally, make sure you find out if you must meet a deductible before insurance kicks in for the chiropractor. Here’s a look at what some of the top providers will cover — and what they won’t — when it comes to chiropractic care.

Blue Cross Blue Shield

BCBS coverage varies from state to state and forms of policies, but in general, it will cover chiropractic services that are deemed medically necessary and when certain criteria are met, including:

• The service must help diagnose, cure, or treat an illness, disease, or injury, not for experimental or cosmetic purposes.
• It must reflect general standards of medical care.
• A patient’s clinical symptoms must be improved by chiropractic therapy and a treatment plan is documented.

Blue Cross Blue Shield does not cover chiropractic services that are deemed as supportive care or maintenance, including counseling, low-level laser therapy, or hydrotherapy.

Aetna

Aetna covers chiropractic care when it is deemed medically necessary. That means all of the following needs to be met:

• The patient has a neuromusculoskeletal issue.
• Treatment is a medical necessity.
• Improvement is seen within the first 2 weeks of receiving care from a chiropractor.

If improved is jot documented within the first month of chiropractic treatment, continuing the care is not considered medically necessary.

Cigna

Cigna covers chiropractic care such as spinal manipulation and related therapeutic approaches if they meet the following conditions:

• A patient has been diagnosed with a neuromusculoskeletal condition and that chiropractic treatment may restore function.
• The care is performed by a licensed doctor of chiropractic licensed by the state.
• The treatment documents significant improvement, symptoms are treated and a treatment plan is followed.

Cigna stipulates that it does not cover chiropractic care if it’s not medically necessary including procedures not related to a patient’s condition or services are duplicated by another doctor or physical therapist.

To learn more about if health insurance covers the chiropractor, contact us today. Each health situation is unique in its own way. As chiropractors, we are here to help in all the ways that we can.