Understanding how your medical insurance works for chiropractic treatment
Dealing with the world of medical insurance is unfortunately a big part of my life as an owner of a Chiropractic office in Livermore. The ‘unfortunate’ part of it is that it can be confusing to my patients and also frustrating to deal with. As I was helping a patient understand their health insurance benefits today, I thought about sharing some of the insurance ‘lingo’ so that it can avoid a lot of the confusion that takes place.
To begin, I must explain that most health insurance is not really “health” insurance, rather it is better understood as “sick” insurance. Meaning, medical insurance is there in times of crisis not really to keep a person healthy to prevent illness. Just like auto or home insurance, medical insurance is really a ‘just-in-case’ peace of mind. Most medical insurance companies will benefit situations where someone has to go to the hospital or doctor for some type of medical emergency. Some medical insurances will cover doctor visits including chiropractic visits too but there are stipulations.
For example, a patient who came in with an insurance plan with 20 chiropractic visits per year was denied visits from the medical insurance company.Once we spoke to a ‘live’ person at the insurance company, they stated that the patients visits was not considered “medically necessary“. What that meant was that since the diagnosis code was not a code that was a “crisis” situation the insurance company wouldn’t validate a visit just for maintenance. This might sound shocking but this is how most policies are written (in small print of course). In most cases, patients who use their medical insurance for chiropractic visits are using it for the purposes of pain relief and “crisis” type situations however, if a patient wants to get their spine’s rehabilitated after the pain has subsided, or if they want to tune up their spines to prevent future injuries, insurance companies will call that “medically unnecessary“.
It is important to realize that being healthy and staying healthy requires you to take it into your own hands and wallets most cases. Just like paying for a gym membership, vitamins, healthy foods and other preventative services, it is usually worth the investment to prevent the headaches of large bills, taking time off work and a decreased quality of life because of untreated pain or injuries.
