Your Plan May Feature Some Coverage for Chiropractic Care

According to the American Chiropractic Association, approximately 35 million Americans go to a chiropractor every year. This type of care is particularly helpful for treating back pain resulting from a car accident, work or exercise-related strain or an injury. Seeing a chiropractor can be expensive, but fortunately, most health insurance companies provide coverage for treatment.

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How Does Health Insurance Cover Chiropractic Treatment?

The Affordable Care Act includes 10 categories of essential health benefits that all major health insurance plans are required to provide. Among these benefits is coverage for habilitative and rehabilitative services that help those with injuries or illnesses regain physical skills.

While this does not expressly include chiropractic care, most health insurance plans cover this treatment option. In fact, it is estimated that roughly nine out of 10 workers have chiropractic care covered under their employer-subsidized health insurance.

In some cases, health insurance companies require policyholders to get referrals from their doctors before making an appointment with a chiropractor.

Does Health Insurance Cover Chiropractic Care?

Does Health Insurance Cover Maintenance Chiropractic Care?

While your health insurance company may cover short-term chiropractic care to treat a specific injury, it probably does not cover maintenance care, or care that you get on a regular basis to maintain your health rather than treat a condition. That is because many health insurance companies do not see maintenance chiropractic care as a medical necessity. While they may cover care to help policyholders recover from an injury, they are unlikely to cover services that do not have a clear benefit or bring about signs of improvement. Some plans may cover “Manual Manipulation” which applies to Medical-Physician Services and Chiropractic office visits. These benefits may be subject to a maximum benefit of twenty (20) visits per insured per calendar year. You will need to look at your individual plan’s “Summary of Benefits” guide or “Agreement of Coverage” to verify these benefits.

How Do Health Insurance Companies Limit Coverage for Chiropractic Care?

While most health insurance companies provide coverage for chiropractic care, there are several ways in which they limit coverage. Rules vary from one plan to another, but in general, most health insurance companies limit how many times you can visit your chiropractor over the course of a month or year. For example, your plan may cover 20 visits per year, and you may have to obtain care within a certain timeframe. As is the case with general care practitioners and specialists, some health insurance companies require that you see in-network or approved chiropractors. They may also require that you get a referral from your doctor to see a chiropractor, and they may require your doctor to create and follow a care plan.

Your health insurance company may place additional limits on chiropractic care. Talk to a licensed health insurance agent if you are not sure how your plan covers this type of service.

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