Is my chiropractor's approach to the insurance policies regarding treatment gaps and limitations for my pain accurate?

Question

Hello doctor,

Two months ago, I received treatment for my condition, and unfortunately, the same muscle issue resurfaced last week. My chiropractor is hesitant to initiate a new insurance claim until a year has passed, and I cannot recall the exact reason why he is unwilling to provide maintenance treatment when, to my knowledge, The insurance claim does not limit the number of visits. However, this is not preventive maintenance; it is necessary due to the ongoing pain. Frustratingly, he is considering closing his practice. Is he correct in his understanding of insurance policies? Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

The regulations governing chiropractic care can be complex and may not always favor patients. As per the regulations:

Coverage under insurance extends only to treatment involving manual manipulation of the spine to correct a subluxation, as long as it is legal in the state where it is performed. Other services or procedures ordered by chiropractors are not covered.
X-rays or diagnostic procedures ordered by chiropractors for documenting a subluxation can be used, but there is no coverage or payment for these or any other diagnostic or therapeutic services provided by chiropractors.
Chiropractic maintenance therapy is not considered medically reasonable or necessary under the insurance program and is not payable. Maintenance therapy aims to prevent disease, promote health, or sustain the quality of life, and when the treatment becomes supportive rather than corrective, it is considered maintenance therapy.

I hope this helps.

Please revert in case of further queries.

Thank you.