Do You Need Health Insurance to See a Chiropractor?

When you need to visit your doctor for a routine matter, you are probably confident your health insurance will cover your medical expenses. But what if you need to see a chiropractor? Having chronic pain and possibly limited range of motion is not something you want to leave untreated.  But you also want to know if your health insurance will cover chiropractic care, especially if you will require multiple visits. 

Chiropractic care is more common than you might think. Approximately 20 million Americans visit their chiropractor every year for treatment of various musculoskeletal issues, according to the National Center for Complementary and Integrative Health (NCCIH). And people like you are also spending a lot of money on chiropractic care, upwards of $4 billion, as estimated by the NCCIH. 

The good news is that health insurance more often than not will cover some or most chiropractic treatments. This is generally the case for health insurance providers such as Medicare and Medicaid, as well as policies purchased from the marketplace established by the Affordable Care Act (ACA). 

But it is not uncommon for health insurance to be quite limited when it comes to chiropractic care coverage. Also, the majority of chiropractors, require a referral from their doctor. 

What is Chiropractic Care?

Chiropractic care is a type of health care that entails making adjustments to your spine and other areas of your musculoskeletal system. The objective is usually to alleviate pain or improve the range of motion. Chiropractors utilize different methods in their treatments such as stretching, applying pressure, and manipulating the spine. 

Reasons for visiting the Chiropractor include:

  • Sharp pain in the back or legs
  • Intense headaches
  • Recent car accident
  • Sports injuries
  • Stiff shoulders or neck
  • Joint pain

A common motivation for people to seek chiropractic care is to avoid taking medications to quell their pain issues.  Additionally, chiropractic services are sought out to complement other treatments such as surgery and physical therapy. 

When Does Health Insurance Cover Chiropractor Visits?

Traditional health insurance usually covers chiropractic services. But, as mentioned above, that coverage often comes with various limitations or specific requirements. 

An example of this is certain health insurance plans mandating a doctor’s referral prior to seeing a chiropractor. There are other plans that will place limits on how many chiropractor visits are allowed over the course of a month or a year, for example.  Some health insurance plans cap the amount of money the insurance company will pay out over a specific period of time. 

The ACA can but is not required to cover chiropractic services. Fortunately, most ACA plans provide, at minimum, at least partial coverage for chiropractor visits. 

Employer-based Coverage for Chiropractic Services

Employers tend to provide a wide array of health insurance coverages to their employees. It varies wildly when it comes to chiropractic care that is mostly or completely covered with employer-based health insurance. 

In general, job-based health insurance is likely to cover some of your chiropractor visits. 

Here are several typical health insurance coverage limitations for chiropractic services:

  • A majority of health insurance plans will cover chiropractor treatments only if a physician says they are medically necessary and then prescribes them. This means obtaining a doctor’s referral.
  • Quite a few health insurance plans place a cap on the number of chiropractor visits in a month or year. They will also restrict the amount of money they will authorize for chiropractic services. 
  • You will probably have to show sooner than later the medical need to continue chiropractic services. If not, chiropractic care transitions into “maintenance” or “long-term” care, which health insurance companies will likely not cover. 

Medicare Coverage for Chiropractic Services

Similar to employer-based health insurance, Medicare covers some chiropractor visits, but usually not that many. An example of this is Medicare Part B, which pays for “manual manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider.”

The term “medically necessary” translates into your doctor having to approve you for receiving chiropractic care. 

You should be prepared to pay about 20 percent of the Medicare-approved amount for chiropractic treatment. This is contingent on first meeting your Part B deductible. If you have not, you must pay full price for chiropractic services until you have paid up to your deductible. Afterward, you will pay 20 percent of the cost for care. 

Medicaid Coverage for Chiropractic Care

Like Medicare, Medicaid also usually covers only some chiropractic care, and there are limitations on that health insurance coverage. As they are both government versions of health insurance, Medicare and Medicaid have many similarities when it comes to chiropractic care coverage. 

However, one major difference is that the federal government operates Medicare. The states have a certain flexibility in how they implement Medicaid. For example, the states are required to provide certain “mandatory” benefits, however, others are optional. Examples of mandatory Medicaid benefits are the following:

  • Physician care
  • Inpatient and outpatient hospital care
  • Lab and X-ray tests

“Chiropractic services” are an optional benefit under Medicaid.  Chiropractic services are associated with things like:

  • Prescription drugs
  • Dental, hearing, and vision care
  • Physical and occupational therapy

As all of these types of care are optional, and not all Medicaid programs cover them. 

Chiropractic Care of Tri-Cities and Health Insurance for Chiropractic Services

Insurance usually pays for chiropractic services.  We, at Chiropractic Care of Tri-Cities, will bill insurance claims on your behalf.  We are preferred providers for most insurance carriers that have chiropractic benefits, including HMOs (like Group Health) and PPOs (like Blue Cross), and Medicare Part B. 

Chiropractic Care of Tri-Cities is part of the Labor and Industries (L&I) provider network allowing us to provide care for workman’s compensation claims due to on-the-job injuries. We also help individuals who have been involved in auto accidents and personal injury claims.  We have a long history of working with attorneys and providing what is needed to satisfy all parties.

Am I covered?  Call Chiropractic Care of Tri-Cities for verification:  (509) 946-0631!

Get your Body Back on Track with Chiropractic Care of Tri-Cities

Whether you suffer from neck and back problems, related nerve conditions, disc problems, muscle sprains, strains, headaches, or other musculoskeletal symptoms, Chiropractic Care of Tri-Cities offers evaluation, diagnosis, and gentle manual treatment for these issues.  

Chiropractic care is an approach that uses no drugs or surgery. Our treatment is one that uses natural means to encourage the body to heal itself, just as we are designed to do. At Chiropractic Care of Tri-Cities, we treat our patients by restoring proper movement and positioning of dysfunctional joints, all while emphasizing careful treatment of patients.

We want to help you get your body back on track.  Read our Frequently Asked Questions and then give us a call today to schedule your new patient appointment – 509-946-0631 – or you can request an appointment online.