The dynamic of health insurance has changed drastically over the last several years. Guidelines are becoming more and more strict regarding what is covered and what is not. We are required to justify medical necessity for all treatment that is billed to insurance based on the chiropractic guidelines set forth by the individual insurance companies.
In order for treatment to be billed to insurance as medically necessary, the treatment must meet certain criteria. You must be under an active treatment plan with quantifiable, attainable goals for a certain number of treatments. Re-exams must be performed no more than every 30 days to continue care that is filed with insurance to show continual improvement.
Although recommended for maintaining spinal health, the following are NOT considered medically necessary treatment for billing to insurance:
In addition, there are some therapies and treatments that the doctors recommend in certain cases that may not be covered by an individual policy and can not be billed. These vary from policy to policy, but may include any or all of the following:
If all or some of your treatment is not expected to be paid by insurance, then you will be asked to pay for that treatment/service out of pocket. The good news is, we have an affordable cash discount program called ChiroHealth USA (CHUSA) that you can enroll in to significantly minimize your out of pocket costs.
We have copies of the chiropractic billing guidelines for the most common insurance available in our office. If you have any questions, are not sure what category of treatment you fall into or need to schedule an exam, please contact our office at (502) 231-4003.