Before seeking most medical care, you want to be sure that your insurance covers that type of care. There is a pervasive myth that chiropractic care can’t be covered under most health insurance plans today. In fact, most plans cover at least some chiropractic services. Like anything else, you may have certain limits or requirements in order to have this care covered. When looking for the best chiropractor in Atlanta, it can be important to understand this coverage in advance so that you can plan for the care you need.
Insurance Coverage for Chiropractic Care
While most insurance will cover visits to the chiropractor, there are often requirements or rules that go along with that. This is true of all major insurance providers like Medicare, Blue Cross Blue Shield, Cigna, Humana, Aetna, and United Healthcare. People who get medical care like veterans, active-duty military, and federal employees usually have access as well.
The details of coverage will vary widely based on your provider and your plan. Some restrictions and rules you may encounter are:
- A referral from your primary care physician stating that chiropractic care is medically necessary
- A cap on how many times you can visit a chiropractor within a monthly or yearly period
- You may have to use in-network or otherwise approved chiropractors
- Your doctor may have to create an active care plan and prove they are following it
Additionally, most coverage is designed for short-term care related to recovery from an injury, rather than preventative and maintenance plans or long-term treatment.
What to Ask Your Provider
If you are trying to determine the exact nature of your coverage, there are a few elements of health care plans to consider.
You first need to understand your deductible. This is a minimum dollar amount you have to pay before your insurance benefits kick in. A deductible doesn’t change based on the type of care, so if you have not yet met this deductible, you will have to pay for chiropractic care until the number is met. The chiropractic treatment will also go towards your deductible.
The next thing to understand is co-pays. This is the amount you pay a provider during a visit. It’s usually a set amount like $25 or $50, depending on whether it is a primary care doctor or a specialist. Even with coverage, you may need to pay a small amount for each adjustment.
From there, you will want to understand what providers are in-network. Being in-network means that a chiropractor has contracted with your insurance to broker your care. When someone is not in-network, you can still visit them, but your costs may be higher.
If you discover that your plan doesn’t cover chiropractic care, you do have the opportunity to appeal the decision. Insurance companies are often motivated by the ability to prevent future complications in your health. It’s usually much cheaper for them to treat something with chiropractic adjustments upfront than it is for them to pay for a serious orthopedic surgery a few years down the line. For this reason, some may be willing to cover your treatment.
When you aren’t covered, you can also often work out a cash plan with your chiropractor. Many will charge less if you pay directly and they don’t have to work with an insurance company.
What About Auto Insurance?
Car insurance operates differently from health insurance in that it will not pay for any treatment upfront. If the insurance company approves your claim and agrees to pay for your expenses, this will come in a lump sum, usually long after you’ve been treated. They do not usually make decisions on what type of care you can receive.
With an auto insurance settlement, you can pay off any open bills you are responsible for under your insurance plan. This may include co-pays, bills that go towards your deductible, or ongoing care.
Care at AICA Atlanta
AICA Atlanta accepts most major insurance plans, and we often work with companies when an individual is not covered. Providers can often reach out to the company directly and explain why your care was necessary as a part of an appeal. Our goal is to get each patient the best care possible, and we do not want insurance coverage to be a barrier to that care.
If you’re not sure if AICA is in-network, or you want to understand what care might be covered, reach out today to schedule your first appointment. Our office staff will work with you to determine the best plan for you.