What insurances do we accept?
- Blue Cross Blue Shield
- Harvard Pilgrim
- Tufts Commercial
- Tufts Public
- United HealthCare
What is Medically Necessary Chiropractic Care?
If you choose to use your health insurance to pay for your care, we must abide by their rules. Health insurance allows you to use your benefits for MEDICALLY NECESSARY CHIROPRACTIC CARE only.
Medicare sets the standards for most other health insurance plans and they define the difference between medically necessary care and maintenance care as the following:
“Maintenance therapy includes services that seek to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvements cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.”
Unfortunately, medical care in the United States for the most part is ‘sick care’, not healthcare. Once acute symptoms are gone or stabilized to a lesser intensity, medically necessary care is complete. Then insurance won’t cover anything else even if it is to maintain the progress that we have made.
Here’s an example: Your chiropractic benefits through your health insurance say that you have 20 visits per year. You start seeing a chiropractor and your symptoms subside at visit 10. You love feeling so flexible and pain free and you want to keep it that way. You know that a month of sitting at your desk will bring back the pain so you want to stay on top of it and continue seeing the chiropractor on a regular basis and you have 10 visits remaining. Can you use these 10 visits? Is this Medically Necessary care or Maintenance care? In most instances, this would be Maintenance care and you are not allowed to use the remaining 10 visits. We know this doesn’t seem fair – after all, you’re paying for your health insurance and you want to maximize your benefits but these are their rules and we must obey them in order to avoid insurance fraud.
Another example is if you have used your 20 visits for the year but you want to come back to your chiropractor to maintain your spinal health for wellness purposes. Your insurance company may tell you that you can acquire more visits with authorization. However, in order to get additional visits for you, we must submit evidence to your insurance carrier proving that these will be used for medically necessary care. Unfortunately, we are frequently asked to get authorization for additional visits for wellness care and while we would love for health insurance to pay for your wellness, it would be considered insurance fraud so we are unable to do so.
Health insurance companies want chiropractors to tell their patients: “Don’t come back unless your pain returns or you injure yourself again”. This is a really hard thing for us to say because it completely goes against our wellness philosophy.
So how can you continue chiropractic care once your symptoms are under control? We are contracted with ChiroHealth USA, which is a network that allows us to set and accept discounts on our services for our members. When you join ChiroHealthUSA, you are entitled to similar “in-network” discounts just like the insurance companies. With ChiroHealth USA, you enjoy unlimited access to the services and providers in the network, and unlike health insurance, they encourage you to use them as often as necessary.
With ChiroHealth USA, we are able to offer additional discounts for pre-paid packages of care as well as discounts for Veterans, Active Military and First Responders.
Our reduced ChiroHealth USA rates are as follows:
- New Patient Appointment: $120 (includes Exam, Adjustments and Manual Therapy)
- Capped fee for follow up visits: $60 (includes Adjustments and Manual Therapy)
- 6-pack of follow up visits: $310
- 6-pack of follow up visits for Veterans, Active Military and First Responders: $279
- ChiroHealth USA requires a $49 annual fee to be a part of the program, which would cover all family members in your household