Dr. Harlan Mittag, DC explains the ins and outs of insurance coverage for chiropractic and holistic therapies.
Chiropractors are covered by many insurances, including major medical, medicare, Minnesota No-Fault and Minnesota Worker’s Compensation. Space limitation allows me to only cover major medical, Minnesota No-Fault and Medicare coverage here.
Most major medical (your regular health insurance) insurances cover chiropractic services in Minnesota. Two of the major Minnesota health insurers are Medica and Health Partners. Both of these insurers generally cover chiropractic services although the amount of coverage does vary from policy to policy. In the case of Medica and Health Partners chiropractic care is available through two unique networks of chiropractors. Maximum coverage is available only when you are treated by a chiropractor in the insurer’s designated network. The list of chiropractors in your insurance carriers network is generally found in your Provider Manual.
Medica and Health Partners will usually cover the following services performed by a chiropractor:
- Examinations – the initial examination is required by health insurers and by professional standards in order for the chiropractor to establish a diagnosis. The diagnosis communicates to the insurance company the reason and justification for any additional services provided by the chiropractor. The examination allows the chiropractor to figure out what problem underlies your (the patient’s) complaints and / or health issue.
- Chiropractic adjustments – adjustments of the spine and joints of the extremities. Adjustments are gentle manipulations of joints made to restore ideal joint function. Adjustments often provide immediate relief of pain. Sequential adjustments (on follow up treatment visits) are needed to retrain normal joint movement. Abnormal joint movement is often the source of local mechanical irritation which underlies joint inflammation and pain. Correcting abnormal joint movement with a series of joint adjustments eliminates the mechanical irritation to the joint and thus the inflammation and pain.
- Physiotherapy – numerous additional therapies such as electrical muscle stimulation, traction and other therapeutic activities are used to help promote healing of an area of complaint. For instance electrical muscle stimulation relaxes tight and sore muscles, promotes blood flow to muscles and blocks the sensation of pain locally.
- Acupuncture – is used to promote healing and alleviate pain. Using the ancient Chinese principal of chi or vital energy, acupuncture balances energy flows in the body to promote healing.
Minnesota No-Fault (Auto Insurance)
If your are injured in an automobile accident in Minnesota, you are covered for chiropractic services from the chiropractor of your choosing. This is the law in Minnesota. You are not required to go to a doctor or chiropractor chosen by the insurance company for treatment of your auto accident injuries.
Beware of Minnesota IME’s (“Independent” Medical Examiners)
(However, your insurance carrier can send you to one of their own doctor’s on a limited basis. Usually this involves a single visit. Almost universally the auto insurance carrier sends their insured to their doctor-who is euphemistically referred to as an “Independent” Medical Examiner-to refute any injuries that were sustained in an accident. At best, auto insurance companies send their clients to IME’s when they want to stop paying for further treatment of the clients injuries. IME’s are notorious for overlooking obvious injuries related to the motor vehicle accidents in question. In my 25 years of practice in Minnesota, having seen countless numbers of my patients sent to IME’s by insurance companies, I can count on one hand the number of times an IME has acknowledged the obvious injury sustained by a patient, and the need for continued care.)
I personally experienced the truth of what goes on between IME’s and insurance companies in Minnesota on one occasion. I had given a presentation to the state wide convention for the Minnesota Trial Lawyers Association. My topic was Whiplash Injuries. An insurance adjuster in the audience was impressed by my presentation and later on contacted me. He wanted to send me a patient to examine-my role being one of an IME. After examining the patient I wrote a lengthy report detailing my findings and stating that the patient had definitely sustained injuries in the motor vehicle accident in question, and still needed ongoing care. The adjuster never sent me another patient. (It also took a long time for me to get paid by the insurance company for the work that I did).
Minnesota No-Fault insurance covers all of the above services (mentioned under major medical insurance) plus some.
Examinations, chiropractic adjustments, physiotherapy, acupuncture and (in addition) massage are all covered chiropractic services under Minnesota No-Fault. Your chiropractor has to appropriately document your condition and show that the treatments provided are directly related to the injuries that you sustained in a motor vehicle accident. If that is done appropriately, there should be no problem getting your chiropractic services covered.
Medicare is a federally mandated (provided) benefit. But your Medicare benefits are sometimes provided through a local insurance company. In either case, Medicare only covers chiropractic adjustments.
While Medicare will only pay for chiropractic adjustments when you see a chiropractor, the chiropractor is required to do an examination to establish a diagnosis for Medicare. But even though Medicare requires that the chiropractor do an examination to establish a diagnosis, Medicare will not pay for the examination. It is difficult to get this fact across to patients (because it is so illogical). So if you have Medicare and see a chiropractor, expect to pay for an examination on the first visit. Examinations are not covered by your supplemental to Medicare. Your supplemental to Medicare only covers the portion of the chiropractic adjustment that Medicare will not pay for. What?
While I said that Medicare covers chiropractic adjustments, they do not cover 100% of the chiropractic adjustment. They only cover 80% of the adjustment. The other 20% is either your responsibility (out-of-pocket), or if you have supplemental coverage it will cover the remaining portion.
The bottom line on insurance coverage for MN chiropractors is “Yes, they are covered-depending on a number of variables”.
It can be very complicated. But the bottom line is that most Minnesota insurances do cover MN chiropractors (to different degrees depending on the type of insurance and your specific policy).
Dr. Harlan Mittag is a chiropractor in St. Louis Park and Minneapolis, MN and owner of Mittag Holistic Chiropractic. He is a chiropractor, nutritionist and acupuncturist who specializes in the treatment of natural pain and natural pain remedies. A graduate of Stanford University and Northwestern College of Chiropractic, he has had a clinical practice in Minneapolis, Minnesota for the past 25 years.