If you have health insurance, it makes sense to use it for chiropractic care. Finding a chiropractor near you who takes your plan, and understanding what you’ll actually pay, takes a little homework. This step-by-step guide is written for people in Fairfax, Chantilly and the surrounding area, but the same approach works anywhere.
Step 1: Know Your Plan Type
The type of plan you have shapes your options:
- HMO plans usually require you to see in-network providers and may require a referral from your primary care doctor.
- PPO plans typically let you see in-network or out-of-network providers, with lower costs in network.
- EPO plans generally cover in-network care only, often without a referral but varies.
Your plan type is usually printed on your insurance card or listed in your member account.
Step 2: Check Your Insurer’s Provider Directory
Most insurers have an online directory where you can search for chiropractors by ZIP code. This is useful for knowing where your coverage may extend to. However, it is always a sensible idea to call your insurance provider or the healthcare provider, to ensure that your coverage applies.
Step 3: Call the Clinic
Before booking, call the clinic with your insurance card in hand. Have your member ID, group number and plan name ready, and ask:
- Are you in network for my specific plan?
- Will you help verify my chiropractic benefits before my first visit?
- Do you submit claims to my insurer for me?
A clinic that works with insurance regularly should be able to answer these questions quickly.
Step 4: Understand What You’ll Pay
Even with coverage, you may have costs. Check:
- Deductible: how much you pay each year before coverage begins
- Copay or coinsurance: a flat fee or a percentage of each visit
- Visit limits: the number of chiropractic visits covered each year
- Covered services: some plans cover adjustments but handle other therapies differently
Step 5: Keep an Eye on Your Paperwork
After each visit, your insurer will send an explanation of benefits (EOB) showing what was billed, what your plan paid and what you owe. If something doesn’t look right, ask the clinic or your insurer.
If Your Plan Doesn’t Cover Chiropractic Care
Some plans don’t include chiropractic benefits, and others run out partway through the year. In that case, look for clinics with posted self-pay prices, packages or memberships, and check whether you can use HSA or FSA funds.
Choosing a Clinic
Once you’ve narrowed your list, look for a chiropractor that takes insurance from your specific provider and will help you verify your benefits before treatment starts. Clinics that also post self-pay prices give you a backup option if your coverage runs out partway through the year.
This article is for general information only and isn’t insurance or medical advice. Benefits vary by plan, so confirm your coverage with your insurer. If you need information regarding any medical issues or injuries, you should always consult a healthcare professional.
