What Health Insurance Plans Cover for Chiropractic Care

Most health insurance plans cover chiropractic care, but the amount they cover varies widely by plan and insurer

Whether your health insurance covers chiropractic treatment depends on your specific plan. Some plans cover it fully after you meet your deductible. Others cover it partially, meaning you pay a copay or coinsurance while the plan pays the rest. A small number of plans exclude chiropractic care entirely. The only way to know what your plan covers is to check your policy documents or call your insurer directly.

Coverage also depends on why you need chiropractic care. Most plans cover treatment for acute injuries or conditions like a car accident or a herniated disc. Some plans are more restrictive and only cover care ordered by your primary care doctor. A few plans limit the number of visits you can have per year, often between 12 and 30 visits depending on the plan.

If you have a plan through your employer, your human resources or benefits department can tell you exactly what chiropractic services are covered. If you buy your own plan, your insurer's website usually has a benefits summary that lists chiropractic coverage, or you can call the customer service number on your insurance card.

Key Takeaways

• Coverage for chiropractic care is included in most health insurance plans, but the amount covered and any visit limits depend on your specific plan.
• Your plan may require a referral from your primary care doctor before covering chiropractic treatment, so check your policy before scheduling.
• You typically pay a copay or coinsurance for each chiropractic visit after meeting your deductible, just as you would for other medical care.
• Plans often limit chiropractic visits to a set number per year, ranging from 12 to 30 visits, though some plans have no limit.
• The fastest way to confirm coverage is to call the customer service number on your insurance card or check your plan's benefits summary online.

How to find out what your plan covers

Your insurance card has a customer service number on the back. Call that number and ask whether chiropractic care is covered under your plan. Have your policy number ready. The representative will tell you whether the plan covers chiropractic treatment, what you pay per visit, whether you need a referral, and how many visits per year are covered.

If you have insurance through your employer, your benefits department or human resources office can also answer these questions. They often have a summary of benefits document that lists what is and is not covered. Some employers offer this document during open enrollment or keep it on an internal website.

You can also log into your insurer's website. Most insurers have a tool where you can search for covered services or view your plan details. If you cannot find the information online, the customer service number is the most reliable option.

What you typically pay for chiropractic visits

If your plan covers chiropractic care, you usually pay a copay — a fixed amount like $20 or $30 per visit — or coinsurance, which is a percentage of the cost like 20 percent. You pay this amount after you have met your deductible for the year. Before you meet your deductible, you may pay the full cost of the visit yourself.

Some plans have a separate deductible for chiropractic care, while others use the same deductible as the rest of your medical care. A few plans waive the copay or coinsurance for chiropractic care if it is ordered by your primary care doctor, but this is less common.

Out-of-pocket maximums also explore to chiropractic care. Once you have paid a certain amount out of pocket in a year — your plan's out-of-pocket maximum — your insurance covers 100 percent of covered services for the rest of that year. Chiropractic copays and coinsurance count toward this maximum.

Referral requirements and visit limits

Some plans require your primary care doctor to refer you to a chiropractor before the plan will cover the treatment. Others do not require a referral and let you go directly to a chiropractor. Check your plan documents or call your insurer to find out whether a referral is required. If it is required and you go without one, you may have to pay the full cost of the visit.

Many plans limit the number of chiropractic visits covered per year. Common limits are 12, 20, or 30 visits per year, though some plans have no limit. If your plan has a limit and you exceed it, you pay the full cost of any additional visits. Some plans reset the visit count on January 1 each year, while others use a different date based on when your coverage began.

A few plans limit coverage to treatment for specific conditions, such as back pain from an injury, and do not cover chiropractic care for other reasons. Your plan documents will specify any condition-based limits.

In-network versus out-of-network chiropractors

Insurance plans have networks of doctors and specialists they have contracted with. If you see an in-network chiropractor, you pay your copay or coinsurance and the plan pays the rest. If you see an out-of-network chiropractor, you typically pay more out of pocket, and the plan may cover less or nothing at all.

Before scheduling a chiropractic appointment, ask the chiropractor's office whether they are in your plan's network. You can also search your insurer's website for in-network chiropractors in your area. Using an in-network provider saves you money and ensures the plan will cover the visit as expected.

Some plans do not cover out-of-network chiropractic care at all. Others cover it at a lower rate, such as 50 percent instead of 80 percent. Check your plan documents to understand what happens if you see an out-of-network provider.

What happens if your plan does not cover chiropractic care

A small number of health insurance plans do not cover chiropractic treatment at all. If your plan is one of them, you pay the full cost of each chiropractic visit out of pocket. Chiropractic care costs vary widely depending on your location and the chiropractor, but a single visit typically ranges from $30 to $200.

If you need chiropractic care and your plan does not cover it, you have a few options. You can pay out of pocket for the visits. You can ask your primary care doctor for a referral to physical therapy instead, which most plans cover. Or you can wait until your next open enrollment period to switch to a plan that covers chiropractic care, though this only works if you have employer-based insurance or buy your own plan during the annual open enrollment window.

Some chiropractors offer discounted rates for uninsured patients or payment plans that let you spread the cost over time. It is worth asking about these options when you call to schedule an appointment.

Chiropractic care after a car accident

If you were injured in a car accident, your health insurance may cover chiropractic treatment for injuries caused by the accident. However, the at-fault driver's auto insurance may be responsible for paying instead. This depends on your state's laws and the details of the accident.

In some states, the at-fault driver's liability insurance must pay for your medical treatment, including chiropractic care, up to the policy limit. In other states, your own health insurance pays first, and you can pursue the other driver's insurance for reimbursement later. A few states follow "no-fault" rules where your own auto insurance covers medical expenses regardless of who caused the accident.

If you were in a car accident and need chiropractic care, contact both your health insurance and your auto insurance to understand which one will pay. You may also want to consult with an attorney if the accident was serious or if there is a dispute about who pays.

Frequently Asked Questions

Do I need a referral from my doctor to see a chiropractor?

It depends on your plan. Some plans require a referral from your primary care doctor before they will cover chiropractic care, while others let you go directly to a chiropractor without a referral. Check your plan documents or call your insurer to find out. If a referral is required and you do not get one, you may have to pay the full cost of the visit.

What if my chiropractor is out of network?

Out-of-network chiropractors typically cost you more. You may pay a higher copay or coinsurance, or your plan may cover a smaller percentage of the cost. Some plans do not cover out-of-network chiropractic care at all. Always ask the chiropractor's office whether they are in your network before your first visit.

How many chiropractic visits does insurance cover per year?

Visit limits vary by plan. Common limits are 12, 20, or 30 visits per year, though some plans have no limit. Check your plan documents or call your insurer to find out your specific limit. Once you reach the limit, you pay the full cost of any additional visits.

Does insurance cover chiropractic care for wellness or prevention?

Most plans cover chiropractic care only for treatment of a specific condition or injury, not for general wellness or prevention. If you want chiropractic care for maintenance or prevention, your plan may not cover it. Ask your insurer whether wellness visits are covered under your plan.

Can I use my health insurance to pay for chiropractic care from a car accident?

Yes, your health insurance can cover chiropractic treatment for injuries from a car accident. However, the at-fault driver's auto insurance may be responsible for paying instead, depending on your state's laws. Contact both your health insurance and auto insurance to determine which one will pay.