Are chiropractors covered by insurance? Yes, and it primarily started with the growing demand of patients that needed help with low back pain. Low back pain is the leading cause of disability worldwide, with an estimated 619 million people experiencing back pain in 2020. Annually, nearly 65 million Americans experienced a recent episode lower back pain.
Back pain is not just the leading cause of disability, it is a significant contributor to workplace absenteeism, affecting productivity. Addressing back pain promptly is crucial, and seeking the right professional for treatment is key to addressing the underlying issues rather than merely masking them with medication.
This is where chiropractors play a vital role. Many patients visit their family doctor and will receive pain medications and muscle relaxers, which do nothing to address the actual cause of the pain. This leads to frequent reoccurrences and an escalation in the strength and addictiveness of the medication being prescribed.
Patients will often go through full bottles of over-the-counter medications in an attempt to get through their day. Pain medications combined with many gadgets and contraptions to help them get through their day is expensive and just doesn’t work. Chiropractic care is an affordable option to just get pain relief, but to address the cause of the pain and return patients to their daily activities feeling better than before.
However, a common concern for many is the cost associated with chiropractic care. Are chiropractors covered by insurance? If it is covered, are some plans better than others? Of course, but there are limitations on which services are covered and the number of visits approved as being “medically necessary.”
Understanding Chiropractic Care
Chiropractors employ hands-on spinal adjustments and other supportive therapies to improve posture, alleviate symptoms, and enhance overall well-being. This includes addressing the cause of low back pain, among other conditions. The philosophy behind this approach is that proper alignment of the musculoskeletal structure enables the body to heal naturally, without the need for medication or surgery. Regularly, studies are performed that demonstrate the effectiveness of chiropractic care for low back pain.
Is There Insurance Coverage for Chiropractic Care?
So, are chiropractors covered by insurance or not? The short answer is yes, chiropractic care is generally covered by insurance. Despite being considered alternative medicine by most insurance companies, all of these companies carry plans that cover chiropractic care in some form. Very few, if any, will cover care at 100%. There’s usually a deductible and/or a co-pay or some percentage of treatment that will not be fully covered.
Insurance companies that cover chiropractic care include Medicare, some Medicaid plans, and major providers like Blue Cross Blue Shield, Aetna, United Healthcare, and Cigna. However, specific treatment parameters may vary depending on your benefit type.
Insights into Major Insurance Plans
Blue Cross Blue Shield Insurance
Robust coverage is provided, subject to meeting medical criteria, clear diagnosis, and documented treatment plans. Blue Cross Blue Shield has many plans that cover chiropractic care. For Chiropractic care to be considered for coverage, a patient’s case must meet the following criteria:
- The service provided must be geared towards diagnosis or treatment of a medical condition, injury, illness or disease
- It must be necessary for treatment, cure or relief of symptoms
- The treatment must meet generally accepted standards of care
- The patient must have symptoms that can be alleviated by chiropractic treatment.
- Treatment is performed by a licensed chiropractic professional
- There is a clear care plan detailing a clear diagnosis, a treatment plan detailing symptoms, a clear outline of diagnostic procedures and treatment modalities, anticipated length of treatment, and both long and short-term treatment goals.
Coverage is available for neuromusculoskeletal disorders with documented improvement within the first two weeks of treatment.
Aetna considers chiropractic services as acceptable medical treatments when they meet the following criteria:
• The patient has a neuromusculoskeletal disorder (problem that is due to bones, muscles, and nerves – like back pain or sciatica)
• The medical necessity is clearly outlined and documented
• There is documented improvement within the first two weeks of initiating treatment
With no notable improvement in two weeks, a treatment is considered not medically necessary, unless a patient takes on different Chiropractic treatment.
Also, treatment in patients that are not improving or regressing is not considered as medically necessary. This means it does not get covered. If the patient decides they want to continue care anyway, they would need to pay out-of-pocket for any services not covered by insurance.
Chiropractic manipulation is covered with a diagnosed neuromusculoskeletal condition and a clear treatment plan. The care and condition must meet the following criteria:
• Care is performed by a licensed chiropractor
• A neuromusculoskeletal condition is diagnosed, with an expected positive outcome from chiropractic care
• The patient has a clear outline of the prescribed treatment, symptoms, diagnostic procedures and outlined expected results
• The care plan documents the frequency, duration and expected results of planned treatments
• There is information on the anticipated length of treatment with quantifiable long and short term goals (this can be expected decrease in pain levels or ability to perform specific tasks)
Additionally, while your Cigna insurance plan may indicate you have a specific number of treatments available to you each year (like 30 visits, for example), Cigna will determine the permitted number of visits based on the severity of the condition and your response to care. Regular paperwork and updates are typically required when using this plan.
Similar to other providers, coverage is provided for diagnosed neuromusculoskeletal conditions with documented treatment plans. United Healthcare has the following criteria, and specific paperwork must be submitted for an approval of visits within 10 days of starting care:
• Care is performed by a licensed chiropractor
• A neuromusculoskeletal condition is diagnosed, with an expectation of a good outcome from chiropractic therapy
• The patient has a clear outline of the prescribed treatment, symptoms, diagnostic procedures and results
• Patient’s daily notes document the frequency, duration and results of planned treatments
• There is information on the anticipated length of treatment with quantifiable long and short term goals
Additionally, while your insurance plan may indicate you have a specific number of treatments available to you each year (like 30 visits, for example), United Healthcare will determine the permitted number of visits based on the severity of the condition and the patient’s response to care. Regular paperwork and updates are typically required when using this plan.
Chiropractic Services Without Insurance
In some cases, patients may need to pay out of pocket due to lack of insurance coverage or specific insurer exemptions. Your chiropractor can guide you on the best approach based on your circumstances. We do provide up-front pricing and always provide a good faith estimate at the beginning of care. Our prices are always available on our website, so you know what to expect.
At CORE Chiropractic, we will always give our best recommendations based on your condition. If limitations to your available time or financial resources make that plan difficult, we will work with you to help you get the most effective care you can in our office. If you are not able to follow our recommendations, that does not mean we will not accept you as a patient. It will likely mean that we will give you more things you will need to do at home in order to still get great results.
Finding the Best Chiropractor, With Or Without Insurance Coverage
Whether you’re using insurance or paying out-of-pocket, finding the best chiropractor is essential to getting great results. Consider getting referrals from your social circles, conducting online searches, reading online reviews, and checking who is in-network with your insurance policy. Meeting the chiropractor for a brief initial consultation can also help determine compatibility.
In conclusion, chiropractic care is indeed covered by insurance, but it’s essential to understand the limitations. If you’re considering chiropractic care, reviewing your insurance policy is the first step in assessing your treatment options.
Some services such as spinal decompression therapy, PEMF therapy, and HEIT therapy will not be covered by any health insurance plan. While effective and helpful for different conditions, health insurance companies have in their policies that only the chiropractic care and some specific therapies are covered.
These specialized treatments may be considered “investigational” or “experimental” even if some form of this therapy has been around for many years. This is primarily due to a lack of published studies. Each patient can make the decision whether or not to include these therapies in their specific care plan.