Acute Vs. Maintenance Care:
ACUTE CARE is short-term in nature. This would be care for a recent injury or other issue which will result in significant functional improvement and decreased pain within a predictable period of time (generally within a period of two months). This care requires frequent visits that reduce in frequency as the patient improves. This is the only type of care that is considered by the insurance industry to be "medically necessary" and potentially covered by any insurance benefits.
MAINTENANCE CARE is meant to prevent future relapses and maintain the condition after active care has been completed. This is also known as Wellness or Preventative Care. The insurance industry considers maintenance/preventative chiropractic care to be "not-medically necessary" and therefore does not cover these types of visits. This is similar to your car insurance not covering oil changes and tune-ups which are required for proper vehicle maintenance.
Frequently Asked Questions:
Is there a certain amount of treatment that is covered?
The amount or length of treatment that is covered by insurance is not necessarily defined by the number of visits. Rather, the treatment is covered for a short period (generally under two months) as long as it demonstrates significant, lasting, or progressive improvement to your condition (as measured by subjective and objective findings, improvements in activities of daily living, etc). This type of care would typically never exceed a 2-week gap between visits.
When is chiropractic care NOT covered by my health insurance plan?
Chiropractic care is not covered by your health insurance when you reach a point in treatment where symptoms remain stable or where you no longer show progress in reducing these symptoms. Chiropractic care is generally not covered after a period of active/acute care lasting approximately two months. Even though the patient may still have some degree of pain or discomfort, once their improvement has leveled off they must be released from active/acute care and placed onto a maintenance program of care (which insurance does not cover).
"I just want to come in whenever I feel I need to and I don't want to be on a treatment schedule."
That's okay! However, you need to understand that chiropractic treatment provided on an "as-needed" basis is determined by the insurance industry to be "not-medically necessary" and is therefore not covered by insurance. Even if your insurance benefits say you have a certain number of chiropractic visits per year, those visits need to fall under an active treatment program prescribed by the chiropractor in order to be covered.
“I want to receive maintenance/preventive care”
That’s a great idea! Many people choose to be proactive about their health and decide to receive chiropractic care as part of their “health routine”. In this situation you would participate in one of our “Health Care Made Affordable” cash programs, which provide you and your family with an affordable way to receive chiropractic care.
"But my insurance says that I have 12 visits per year covered."
Insurance will only pay for services that it determines to be "Medically Necessary". If the 12 visits are used during an active treatment protocol then they should be covered; however, if the 12 visits are used on an "as-needed" or "once-a-month" basis then insurance will not cover those visits. Non-covered services also do not apply towards any deductible so there is no need to even bill insurance for this type of service.
"Can I go back on active care once I've been on maintenance care?"
Yes, if you sustain a future incident or injury, your chiropractic care would again meet the criteria for acute care and would be covered by your health insurance. Insurance coverage will stop once that condition does not show any more improvements, both subjective and objective.
“Can I use my HSA (or equivalent) to pay for chiropractic services?”
In most cases, yes! Many people choose to use their HSA’s to pay for their chiropractic care.
"If my insurance won't pay, then I can't afford it."
About 85% of the patients in our office come in to receive maintenance/preventive care, and therefore pay out-of-pocket. This is the purpose of the “Healthcare Made Affordable” cash program that is available in our office. Unlike most medical care, chiropractic care is very affordable. An entire year of chiropractic care usually costs less than what most people spend on a new computer! How we spend our money is all about priorities. We often don't think twice about spending a large amount of money on entertainment, but when it comes to our health we tend to put in on the back-burner…until it’s too late. It is much cheaper (and wiser) to invest a small amount in prevention instead of waiting for a health problem to get more serious. Chiropractic care is by far the best deal in healthcare!