How the health plans typically deal with Chiropractic care

In recent years, Chiropractic coverage has become more commonplace in California health insurance plans.  In general, health plans have slowly moved towards covering more preventative health care and alternative health care costs.  Chiropractic is usually grouped under the "alternative health care" banner with acupuncture but it has become more mainstream both in terms of use and as a matured and licensed means of medical care.  When you run a California health insurance quote, you will see chiropractic care broken out separately from office visit copays and usually, it is grouped with physical and occupational therapy.  Since the underlying issues that require chiropractic care are typically more chronic in nature (last long periods of time if not indefinitely), there may be caps on the number of covered benefits in a given year.  Some health carriers may allow more covered benefits but authorization is required first.   On the Small Group market, some health plans offer Chiropractic riders which add additional or better chiropractic benefits.  A "rider" is a like a side insurance plan added to the main medical plan.  The "rider" can cover chiropractic, cancer, infertility, or a specific medical benefit that traditionally is not covered or has limited benefits compared to the core medical plan coverage.

Chiropractic coverage usually has the the carrier paying a fixed amount such as $25 for a covered visit.  With some plans, the main deductible may be waived for chiropractic coverage. 

Chiropractic care better explained

For further reference, an explanation of Chiropractic as described by Health360 through Blue Cross of California

The art of joint manipulation has been practiced for thousands of years. The ancient Greeks and Romans recognized the beneficial effects of spinal manipulation and passed this technique down from generation to generation. The birth of chiropractic as a healing profession occurred in the U.S. in 1895 with the founding of the first College of Chiropractic, based on the philosophical principles that spinal health was vital for overall wellness. It was believed that any disease could be cured by manipulating or realigning the spine in order to heal the body.

Chiropractic today is somewhat different from the original discipline which involved more spiritual and metaphysical aspects. Today, the central premise is that malfunctions or misalignments of the vertebrae (bones of the spine) cause interference in the proper functioning of the nervous system, which then affects the body’s health and overall performance. These misalignments are called spinal joint fixations (or subfluxation) and result in nerve irritation which is believed to cause muscular tension, posture problems, limited or painful movement, and a variety of other problems. A chiropractic adjustment or manipulation works to remove spinal joint fixations and reduce nervous irritations. Chiropractic procedures are drug-free and surgery-free. Chiropractic medicine believes that good health depends on the normal function of the nervous system, because nerves influence all body tissues. Chiropractic can increase motion, increase circulation, reduce swelling and pain and allow the body to heal itself.

In addition to manipulation, many chiropractors use techniques such as exercise, nutritional counseling, and physiotherapy, although almost all chiropractors use spinal adjustment as their primary treatment approach. In 1994, the Agency for Health Care Policy and Research identified joint manipulation as an acceptable method of treatment for relief of acute low back pain. To date, there is no scientific evidence to support the effectiveness of chiropractic for problems other than low back pain but the first federally funded research is currently underway to study the effects of chiropractic on other health problems and the results will be published in the near future.

Chiropractors may have varying techniques and routines, but a typical visit involves taking your personal and family health history along with a physical exam, blood pressure, pulse and respiration (breathing) measurements, and possibly order a blood test. Your posture will be analyzed as well as your joint movements to determine areas of fixation. The chiropractor may also take an X-ray of the area where you are experiencing pain, before beginning manipulation treatment. Although the spine is the main area of focus, chiropractic manipulations can be applied to any muscle or joint in the body. At the time of the treatment the chiropractor will give advice about nutrition, exercise, stretching, and posture to avoid future problems. On average, a course of treatment for a specific problem involves 3 to 5 visits per week for 2 weeks. If pain continues, you should see your regular physician for further evaluation.

The goal of chiropractic treatment is relief of musculoskeletal pain and restoration of mobility. However, many people use chiropractors for a wide variety of ailments. If your problem isn’t clearly related to the back or the joints, you should check with your physician. If a chiropractor discovers a problem that requires medical attention, he or she should refer you to your physician right away. Chiropractors are not trained to diagnose the full range of diseases. Chiropractic is not recommended for people who have osteoporosis, bone or joint infections, bone cancer, rheumatoid arthritis, spinal chord or bone marrow diseases, and areas of previous fractures or spinal surgery.

There are currently more than 50,000 chiropractors in the United States and all are required to have attended an accredited 4-year chiropractic college and pass state licensing exams. To find a chiropractor in your area, ask your physician, or contact the American Chiropractic Association (800) 986-4636. Always discuss your condition and expectations beforehand, and determine if you feel comfortable with the chiropractor’s treatment plan and philosophy. Check with your benefits administrator regarding coverage for chiropractic services under your health care plan.

This information is provided for educational purposes only and is not a substitute for sound medical judgment. If you have any questions or concerns, you should discuss them with your physician.