Ever thought about getting chiropractic treatment but weren’t sure if a chiropractor is covered by insurance? If so, there’s good news; many insurance plans do offer some level of coverage for chiropractic care. However, the answer isn’t always straightforward. Your coverage depends on your provider, your specific plan, and whether your treatment is deemed medically necessary.
Dealing with unexpected costs can be a real pain in the neck. To save yourself the trouble, take some time to understand how insurance coverage works before scheduling a chiropractic appointment. This article covers everything you need to know about which insurance plans apply to chiropractic care and how much they typically cover.
Is My Treatment with a Chiropractor Covered by Insurance?
Most insurance plans offer at least some level of coverage for chiropractic care. However, coverage varies depending on your provider, plan, and whether your insurance company deems chiropractic care medically necessary. Health insurance typically covers the following chiropractic treatments.
Spinal Adjustments
Spinal adjustments (also known as spinal manipulations) are one of the most common chiropractic treatments. They help realign the vertebrae, relieve pressure on nerves, and improve mobility. Insurance providers cover spinal adjustments because they’re proven to be effective for:
- Chronic back and neck pain
- Sciatica
- Tension headaches and migraines
- Joint pain and stiffness
Initial Consultations and Exams
Before starting treatment, your chiropractor needs to understand your condition and determine the best course of action. That’s why most insurance plans cover a review of your medical history, a physical examination, and diagnostic tests such as X-rays and MRIs.
Physical Therapy Modalities
In addition to chiropractic care, health insurance often covers physical therapy and other additional treatments that help speed up your recovery. Some of the most commonly covered physical therapy treatments include:
- Electrical stimulation therapy: This treatment method uses mild electrical pulses to relax muscles and reduce inflammation.
- Ultrasound therapy: This treatment uses sound waves to improve circulation and promote tissue healing.
- Therapeutic exercises: This includes exercises that strengthen muscles, improve posture, and enhance mobility.
Does Insurance Cover All Treatments?
While insurance typically covers chiropractic treatments for recovery, they often exclude certain services. For example, you might not be eligible for coverage for massage therapy, maintenance or preventive visits, or advanced treatments such as laser or decompression therapy.
Because chiropractic coverage varies by plan, it’s always a good idea to check your benefits before booking an appointment. If you’re unsure what’s included in your plan, an experienced chiropractor can check for you.
What Insurance Covers Chiropractic Care?
You may be wondering “Is my chiropractor covered by insurance?” The good news is that many private health insurance companies in Illinois offer chiropractic benefits. For example, Blue Cross Blue Shield of Illinois covers chiropractic care when a doctor determines it’s medically necessary. If you have an HMO plan, there’s usually a 25-visit limit per year for chiropractic and osteopathic manipulations.
Other companies such as United Healthcare, Aetna, Cigna, and Humana also include chiropractic benefits in many of their plans. However, coverage specifics (e.g., visit limits, co-pays, and referrals) vary.
Does Medicare Cover Chiropractic Care?
Medicare Part B provides limited coverage for chiropractic treatment, specifically for manual spinal adjustments to correct a vertebral subluxation. However, it doesn’t cover other common chiropractic services, including X-rays, massage therapy, acupuncture, or any additional tests that your chiropractor orders.
If your chiropractor recommends these services, you may need to pay out of pocket or check if you have supplemental insurance that covers them. Additionally, you’ll need to meet your Part B deductible before Medicare starts covering any costs. Once you meet your deductible, you’re typically responsible for 20% of the Medicare-approved amount for each covered chiropractic visit.
The exact amount you’ll owe depends on:
- Other insurance plans you’re enrolled in.
- How much your chiropractor charges for services.
- Whether your provider accepts Medicare assignment.
- Where you receive care.
Does Illinois Medicaid Cover Chiropractic Care?
Medicaid coverage for chiropractic care is extremely limited, which makes it difficult to use it for comprehensive treatment. As of December 1, 2021, Medicaid only covers spinal adjustments, and only if you have a primary spinal subluxation diagnosis.
Even then, the reimbursement rate is just $10.38 per visit, whether the chiropractor is treating one spinal region or all five. Additionally, Medicaid allows only one treatment per session, and a 2.7% rate reduction has been in place since July 1, 2012. Because of these restrictions, you may struggle to get the full care you need using Medicaid. It also doesn’t cover diagnostic exams, imaging, and additional therapies.
Can I Use My HSA or FSA to Pay for Chiropractic Care?
If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use those pre-tax funds to pay for chiropractic care. Since chiropractic treatments are considered a form of medical care, they qualify as eligible expenses under both HSA and FSA guidelines. This allows you to get the care you need while saving money on taxes.
You can use your HSA or FSA debit card to pay for chiropractic treatments, just like any other payment method. If you don’t have your card with you, no worries; you can pay out of pocket and submit a reimbursement request later.
Additionally, you can apply your HSA or FSA funds to deductibles, copayments, and coinsurance. Unlike some insurance plans that require a doctor’s referral before covering chiropractic care, HSA and FSA funds can be used freely with no extra approvals required.
What Types of Insurance Does a Chiropractor Take?
It’s not enough to find a chiropractor who takes insurance. Make sure a chiropractic clinic takes the insurance you carry, so you don’t end up paying 100% of the cost out of pocket. Many chiropractors accept a wide range of insurance plans and offer flexible payment options to accommodate patients’ needs.
For example, an in-network chiropractor with several major insurance providers should take BlueCross BlueShield, Aetna, Cigna, and United Healthcare. Additionally, you should find a chiropractor that participates in Medicare.
Is My Treatment with a Chiropractor Covered by Insurance After an Accident?
If you were injured in a car accident or at work, your chiropractic treatment may be fully covered through a personal injury or workers’ compensation claim. However, the exact coverage depends on the details of your accident and your insurance policy.
For car accidents, Illinois follows a modified comparative negligence rule, which can impact how much compensation you receive. Under this rule, if you’re partially at fault for a car accident, your compensation is reduced by your percentage of fault.
For example, if you were found 10% at fault for an accident and your total damages equaled $50,000, your compensation would be reduced by 10% ($5,000), leaving you with $45,000 from the other party’s insurance provider. This reduction affects how much coverage you get for your chiropractic care, as the final payout may not fully cover all your medical expenses.
However, if you’re 50% or more at fault for a car accident, the other driver’s insurance company won’t pay for your damages. This means you must turn to your own insurance policy to cover the cost of chiropractic treatment.
How Do Deductibles and Copayments Affect Costs?
If you have insurance that covers chiropractic care, you might assume your visits will be fully paid for, but that’s not always the case. Even with coverage, most plans require you to pay out-of-pocket deductibles, copayments, or coinsurance before insurance kicks in.
For example, if you have a $1,500 deductible, you’ll need to pay that amount on medical expenses before your insurance begins covering costs. Once you meet your deductible, your insurance may fully cover your visits or require you to pay a copay or coinsurance. If you have a high-deductible health plan, you may need to pay for several visits before your benefits kick in.
How Much Will I Pay for Chiropractic Care with Average Insurance?
The cost of chiropractic care at Algonquin Chiropractic Center depends on your insurance coverage, but the good news is that most patients pay far less than the standard clinic rates.
Your first visit typically falls between $87 and $259, which includes a consultation, exam, and any necessary X-rays. If you need additional X-rays, the cost may be higher. However, if you have insurance, you’ll likely have much lower out-of-pocket costs, depending on your copay, deductible, and specific plan benefits.
Overall, chiropractic care cost less than other pain and mobility treatment options. For example, physical therapy typically runs $300 to $400 per 30-minute session. Pain management injections typically cost over $1,000 per shot without the exam or MRI required beforehand.
Need a chiropractor covered by the insurance you carry? We accept all major insurance plans, including BlueCross BlueShield, United Healthcare, Aetna, Cigna, and more. Plus, we take Medicare! Don’t have insurance? No problem! Dr. Galante can help you explore affordable, flexible pricing options so you can still get the care you need without breaking the bank.
With over 30 years of experience, Dr. Galante is committed to helping you achieve a pain-free life. Ready to take the first step? Call us at (847) 854-2000 or schedule your appointment online today!
