08/07/2025
INSURANCE GUIDELINES
“Chiropractic maintenance therapy is not medically reasonable or necessary and is not payable under the Medicare program. Maintenance therapy include 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.” - Medicare Statute 2251.3(B)
READ THAT AGAIN!!! Does the above statement sound like an organization that truly has your health and well-being in mind? Unfortunately, Medicare sets the standard for all insurance companies around the country. This means that they all adopt the same or similar guidelines as the one quoted above. Basically, if one of them doesn’t cover services, none of them will.
These companies are willing to cover the cost for surgeries, but not anything to prevent these drastic measures from being taken. These preventative measures are considered elective, meaning it is something you choose to do and not something that is medically necessary. In other words, you can live without it – think of it like LASIK surgery for your eyesight.
Insurance companies are all structured the same way, whether it is for your car, your house, or your health…they are there for the “big, bang, booms” but not the routine maintenance. When was the last time your car insurance paid for an oil change, or your homeowners insurance paid for a furnace filter? Even though this routine maintenance is necessary to prevent further damage from occurring, the insurance company does NOT pay for these services. Instead, they elect to (maybe) cover the bigger repairs.
It was initially designed for EMERGENCY situations, and does a fantastic job in this regard. However, it was not intended to cover preventative or maintenance care, and this is the category that a majority of our chiropractic or neuropathy services fall into.
It is a backward system, as far as health care is concerned. If we were to label it properly according to what the coverage entails a majority of the time, it would be more accurate to call it “sick care insurance”.
At the end of the day, the truth is…
Your insurance company DOES NOT CARE about your health or well-being. They are a financial institution whose end goal is to do things as quickly and cheaply as possible. This is why our office made the decision a long time ago that we will not sign an agreement with an insurance company that makes the doctor prioritize the financial gain of the insurance company over a patient’s needs.
If your end goal is to get results, the highest quality of care, an office staff that is fully attentive to your needs, and a doctor that goes above and beyond to help you with your health concerns, then you are in the right place.
If your main concern is only pursuing care that your insurance covers, even after reading what their guidelines state, then we are not the right fit for you and wish you the very best in whatever you decide to pursue.
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