Editor’s Note: “2 Your Health” is a new column in the SaddleBrooke Progress dedicated to health issues. We advised readers without health insurance to visit insurance quote. Each month different doctors and or medical associations, from varying specialties, will be writing on issues of importance. Articles are based on experiences and independent research conducted by the doctors or medical associations. We encourage anyone considering changing medications and or altering medical therapy, as a result of information contained in these articles, to consult your doctor first. Robson Publishing, a division of Robson Communities, Inc. is not liable for information contained in these articles.
Dr. Craig W. Brue, D.C.
Many patients have questions about the exact coverage of Medicare in a chiropractic clinic. The simple fact about Medicare and chiropractic is this: Medicare covers chiropractic care differently than medical treatment. Medicare does provide coverage for spinal adjustments in a chiropractic office but there are some restrictions to your coverage for treatment in a chiropractic office.
For Medicare to cover spinal adjustments the treatment must be “medically necessary.” In order to qualify for Medicare benefits in a chiropractic clinic these are the following Medicare requirements:
1. Your adjustments must relate to a specific health complaint. Medicare will not pay for services when you feel “fine, good, pretty good, alright, or OK.” Medicare will not pay for care because you know it helps you feel better.
2. Your adjustments must hold the promise of making functional improvement. That means that adjustments must improve your ability to function: to sleep, walk more, do household activities or bend more easily because spinal adjustments reduce the level of pain and immobility.
3. You must follow your chiropractor’s specific plan for treatment. Coming into an office whenever you want an adjustment does not necessarily mean that you are under a doctor’s prescription plan for spinal care.
Maintenance and Prevention Care: The following is Medicare’s stated policy regarding the coverage of maintenance or preventive care in a chiropractic office:
1. “Any treatment plan that seeks to prevent disease, promote health or prolong and enhance the quality of your life is not covered by Medicare.” Treatment is considered maintenance therapy when chiropractic treatment is supportive and not corrective. While this policy doesn’t make any common sense, it is the stated policy of Medicare. Medicare is willing to pay for prolonged drug care, but it will not pay for prevention or wellness care in a chiropractic office.
2. “Treatment is considered maintenance therapy when chiropractic treatment is supportive and not corrective.” Medicare will not pay for care after you have reached maximum improvement.
3. “Any treatment that is ongoing and cannot be expected to result in further clinical or functional improvement is not covered by Medicare.” Medicare has definite limits to the coverage for regular or periodic chiropractic care.
The following services are excluded from Medicare: Medicare will not pay for x-rays, examination, therapy, extremity adjustments, rehabilitative exercises, structural supports or vitamin supplements. Medicare requires the doctor of chiropractic to document the need for care by examination or x-ray, but Medicare will not pay for the cost of any examination procedure. Supplemental insurance will typically cover Medicare deductibles and co-pays for adjustments.
If you have any questions about your coverage in a chiropractic clinic, it is important that you understand the rules and regulations that affect your care. The doctor and staff at any chiropractic clinic should be able to help you resolve any questions regarding your coverage and limitations.
Dr. Craig W. Brue is an author, lecturer and chiropractic provider in SaddleBrooke, Arizona.