by Russell Noga | Updated January 31st, 2024
If you’re covered by Aetna and seeking chiropractic care, you may be asking: does Aetna cover chiropractic? The short answer is that Aetna plans often do, but coverage is subject to your plan’s rules and the necessity of the treatment. Read on to understand the specifics of Aetna’s chiropractic coverage and how to optimize your benefits.
- Aetna generally provides coverage for chiropractic services that are medically necessary, with the scope of coverage dependent on individual plan details and requirements for medical necessity.
- The specific conditions that Aetna typically covers include a range of musculoskeletal issues such as back and neck pain, osteoarthritis, and radiculopathies, but there are certain limitations and exclusions, particularly for treatments that are not widely accepted as necessary by the medical community.
- Maximizing your chiropractic benefits with Aetna involves understanding your insurance plan details, using preventive care, tracking expenses, choosing in-network providers, and adhering to preauthorization requirements when applicable.
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Aetna's Chiropractic Coverage Explained
Chiropractic care is typically covered by Aetna, a leading insurance company. However, the specifics of this coverage depend on the details of your individual plan and certain parameters. Familiarizing yourself with these nuances is beneficial for fully utilizing your benefits.
The cornerstone for coverage lies in the concept of medical necessity. Aetna considers chiropractic care medically necessary if it’s directed towards diagnosing or treating a medical condition, injury, illness, or disease. Moreover, the treatment should be essential for relief of symptoms and adhere to generally accepted standards of care. If there is no noticeable improvement within two weeks, the treatment is generally not considered medically necessary unless a different chiropractic treatment is initiated.
Aetna’s coverage often encompasses chiropractic care for neuromusculoskeletal conditions, aligning with the chiropractic focus on human health and the interplay between neuroskeletal and musculoskeletal structures and functions. This means that conditions affecting your nerves, muscles, and skeletal system can be addressed through your coverage.
However, be aware that Aetna’s chiropractic coverage may have certain constraints and exceptions. Your coverage may not include procedures that are not considered medically necessary or widely accepted by the chiropractic profession. These non-essential treatments for illnesses or injuries may be excluded from your coverage.
Does Aetna Medicare Cover Chiropractic?
If you’re enrolled in an Aetna Medicare Advantage plan, you may wonder about your chiropractic coverage. The good news is, Aetna Medicare Advantage plans do cover chiropractic services, subject to the terms of the plan, applicable conditions, and medical necessity. This implies that not only are your chiropractic treatments covered, but also additional services related to your therapy, including diagnostic tests, x-rays, and laboratory tests may fall within your coverage.
The coverage is based on specific criteria. Chiropractic services must:
- Be medically necessary
- Be provided by a licensed chiropractor
- Comply with applicable state laws and regulations
- Be in a suitable setting for diagnosis and treatment
Ensuring that your chiropractor meets these criteria is vital for your services to be covered.
However, bear in mind that not all services are covered. Aetna Medicare Advantage plans do not cover:
- Services that are not medically necessary or unrelated to the diagnosis and treatment of a musculoskeletal condition
- Treatments such as massage therapy or acupuncture
- Services that are not provided by licensed chiropractic physicians
Medically Necessary Chiropractic Services
Let’s delve a little deeper into what Aetna considers medically necessary chiropractic services. These services are covered when improvement is documented within a specific timeframe and when the maximum therapeutic benefit has been achieved, as determined by a chiropractic physician. This means that your treatment plan needs to show signs of improvement to continue being covered.
For Aetna to consider chiropractic services medically necessary, the following criteria must be met:
- Improvement must be documented within the initial 2 weeks.
- If there is no improvement documented within 30 days despite modifying chiropractic treatment, further treatment is not considered medically necessary.
- After reaching the maximum therapeutic benefit, ongoing chiropractic care is deemed unnecessary from a medical standpoint. This means that once treatment goals have been met, regular chiropractic visits may no longer be recommended.
- Additionally, Aetna requires that chiropractic care be ordered by a physician or other licensed healthcare practitioner and performed by a duly licensed and certified provider.
Keep in mind that Aetna deems chiropractic services medically necessary when the member has a neuromusculoskeletal disorder that needs a treatment plan. This means that your treatments need to be part of a plan addressing a specific disorder affecting your nerves, muscles, or skeletal system to be covered.
Commonly Covered Conditions
In terms of the conditions that qualify for coverage, Aetna’s chiropractic coverage includes a range of common musculoskeletal conditions such as:
- Back and neck pain
- Non-infectious inflammatory disorders of the joints, muscles, and ligaments of the spine and extremities
- Intervertebral disc disorders of the spine
- Peripheral joint trauma
This is good news for anyone suffering from these conditions, as it means you can receive chiropractic treatment under your Aetna plan.
Aetna covers chiropractic care for both acute and chronic conditions, as long as the member has a neuromusculoskeletal disorder. So whether you’ve recently injured your back or you’ve been dealing with chronic neck pain, you can receive coverage for your treatments.
Aetna provides coverage for various types of back pain, including:
- Herniated disks
- Lower back pain
- Muscle/tendon trauma
Aetna also extends coverage to conditions such as fibromyalgia for members with a neuromusculoskeletal disorder. This broad coverage allows you to access a range of treatments for your specific condition.
Limitations and Exclusions
While Aetna’s chiropractic coverage is comprehensive, it’s important to be aware of certain limitations and exclusions. Aetna plans commonly have exclusions or limits for chiropractic care, such as experimental and investigational procedures, preventive or maintenance care, and certain treatment techniques.
For instance, Aetna considers chiropractic manipulation for idiopathic scoliosis or scoliosis beyond a certain point as unproven and not covered. Additionally, certain alternative medicine interventions in chiropractic care are considered experimental and investigational by Aetna due to inadequate evidence.
Certain chiropractic techniques such as Activator and Advanced Biostructural Correction are not covered by Aetna as they are not considered medically necessary. In addition, Aetna Medicare Advantage plans do not cover services that are not deemed medically necessary, or that are not directly related to the diagnosis and treatment of a musculoskeletal condition. This ensures that the coverage remains focused on essential medical needs. Before proceeding, confirm whether your proposed treatment falls within these exclusions or limitations.
Navigating Your Aetna Health Insurance Plan
To maximize your chiropractic benefits, you need to:
- Understand your Aetna health insurance plan.
- Delve into the specifics of your plan details.
- Discover in-network providers.
- Understand preauthorization requirements.
By demystifying these aspects, you can optimize your benefits and avoid unexpected costs.
Aetna members have the option to utilize their online account access to locate in-network providers. For non-members or individuals considering membership, Aetna provides a search tool on their website that allows users to specify their plan type and search for in-network chiropractic providers.
Regarding preauthorization for chiropractic services, your chiropractor must follow Aetna’s precertification requirements. Usually, your chiropractor will handle the submission of the required preauthorization request to Aetna on your behalf. Remember, certain services may require preauthorization, so check your plan’s requirements before scheduling appointments.
Checking Your Plan Details
Knowledge is power when it comes to understanding your chiropractic coverage. Reviewing specific details of your Aetna plan, such as deductibles, coinsurance, and out-of-pocket costs, is essential. This involves taking a closer look at your policy documents, contacting Aetna directly, visiting the Aetna website, or consulting with a chiropractor who accepts Aetna insurance.
The deductible represents the initial amount you are required to pay for covered services before your Aetna plan begins covering the costs. Once the deductible is met, you will then be responsible for paying a percentage of your chiropractic care expenses as coinsurance. Understanding these costs is key to planning for your chiropractic treatments.
Aetna insurance plans also have out-of-pocket limits for chiropractic services. In-network services are capped at $8,500 for individuals and $17,000 for families. Being aware of these limits can help you manage your healthcare expenses effectively.
Selecting an in-network provider is a vital step towards maximizing your Aetna coverage. Aetna in-network providers include a range of healthcare professionals such as:
- other healthcare providers
These providers are contracted to accept Aetna insurance plans. Selecting an in-network provider for chiropractic services is advantageous as it enables you to receive coverage and benefits according to the plan’s terms, leading to substantial cost savings.
You can locate in-network chiropractors by:
- Logging into your Aetna account
- Using the search tool on the Aetna website
- Using external resources such as Zocdoc to search for chiropractors that accept Aetna insurance
Choosing an in-network chiropractor can help you optimize your benefits and minimize your out-of-pocket costs.
However, keep in mind that utilizing out-of-network chiropractic services may result in additional costs. These might include higher out-of-network rates and potentially a separate, higher deductible for out-of-network care compared to in-network options. Therefore, it’s advisable to select an in-network provider whenever possible.
Preauthorization may be a key aspect of your chiropractic coverage. Some Aetna plans may require preauthorization for chiropractic services. Hence, verifying your plan’s requirements before scheduling appointments is vital. The process for obtaining preauthorization involves your doctor submitting a precertification request on your behalf, which will then be assessed against Aetna’s preauthorization criteria.
Aetna deems chiropractic services as medically necessary for preauthorization when the member’s condition aligns with specific criteria for neuromusculoskeletal disorders outlined by Aetna. This means your doctor will need to demonstrate that your chiropractic services align with these criteria to obtain preauthorization.
By understanding and complying with these preauthorization requirements, you can ensure your chiropractic services are covered and avoid any unexpected costs.
Additional Chiropractic Services and Aetna Coverage
In addition to standard chiropractic services, Aetna may also cover additional services such as physical therapy and massage therapy, depending on your plan and the medical necessity of these services. Understanding these additional coverages can help you make the most of your Aetna plan and receive comprehensive chiropractic care.
Aetna covers physical therapy as part of chiropractic care when the treatment is for a neuromusculoskeletal disorder, and the amount, frequency, and duration of services are reasonable and necessary. So if your chiropractic treatment plan includes physical therapy, you can rest assured that it’s likely covered by your Aetna plan.
In terms of massage therapy, Aetna does provide coverage if it is included in a physical therapy plan of care and considered medically necessary. However, it’s important to check with your plan and provider to confirm your coverage.
Physical Therapy Coverage
Physical therapy can be an integral part of chiropractic care, especially for conditions requiring extensive rehabilitation. Aetna generally covers medically necessary physical therapy services, with the extent of coverage varying by plan. This means that if your chiropractor prescribes physical therapy as part of your treatment, your Aetna plan will likely cover it.
Medically necessary physical therapy under Aetna encompasses:
- Therapeutic exercise for loss or restriction of joint motion
- Strength training
- Functional capacity training
- Mobility training
It must be prescribed by a healthcare professional. So if your condition restricts your mobility or joint function, your prescribed physical therapy will likely be covered.
The coverage amount for physical therapy under Aetna plans can vary. Some plans may have a maximum payment limit per visit, for example $68, with many plans covering between 20 to 30 therapy sessions per year. It’s advisable to reach out to Aetna’s customer service team at 1-800-872-3862 to confirm your specific physical therapy coverage.
Massage Therapy Coverage
Massage therapy can be a vital part of a comprehensive chiropractic treatment plan, including chiropractic therapy. Aetna may provide coverage for massage therapy if it is considered medically necessary and has been prescribed by a healthcare provider.
Aetna considers massage therapy medically necessary during the initial or acute phase of an injury or illness, but not for prolonged periods. Therefore, if your chiropractor prescribes massage therapy as part of your initial treatment, Aetna will likely cover it.
However, there are certain conditions and restrictions to this coverage. Under Aetna HMO plans, the physical therapy benefit is usually restricted to a 60-day treatment period. Moreover, there is a maximum limit of 36 sessions within a 12-week period for massage therapy. To ensure coverage, Aetna requires that massage therapy be performed by a licensed physical therapist as part of a physical therapy plan of care.
How to Maximize Your Chiropractic Benefits with Aetna
Maximizing your Aetna chiropractic benefits involves:
- Understanding your coverage
- Focusing on preventive care and maintenance
- Monitoring your expenses
- Being aware of your out-of-pocket costs
By taking these steps, you can ensure you’re making the most of your Aetna chiropractic benefits.
Engaging in preventive care and maintenance in chiropractic health can help identify musculoskeletal problems early on, maintain physical health, and prevent conditions such as back and neck pain. This can improve overall health and well-being while reducing the need for more extensive treatments, which minimizes costs when your Aetna plan cover chiropractic care.
Additionally, Aetna provides tools and guidelines to aid in the submission of insurance claims and the collection of payments, enabling members to effectively track their chiropractic care expenses. Being aware of your expenses and out-of-pocket costs can help you manage your healthcare budget effectively and ensure you are making the most of your Aetna chiropractic benefits.
Preventive Care and Maintenance
Adopting a proactive approach to preventive care and maintenance helps manage your health and maximize your Aetna chiropractic benefits. Engaging in preventive care can help identify musculoskeletal problems early on, maintain physical health, and prevent conditions such as back and neck pain. This approach can improve your overall health and well-being while reducing the need for more extensive treatments, thereby minimizing costs.
Aetna provides coverage for a range of preventive chiropractic care services, such as home-based services for homebound individuals and treatments like spinal manipulation and manual therapy. However, Aetna limits coverage for preventive chiropractic visits to 30 per calendar year when they are considered medically necessary. This means you can receive regular chiropractic care to prevent potential issues and maintain your health.
Aetna health insurance includes coverage for chiropractic maintenance treatments. This coverage encompasses services such as spinal manipulation and manual therapy. The extent of coverage may differ based on the specific plan you have with Aetna. Therefore, it’s advisable to check with Aetna directly to confirm your coverage for preventive care and maintenance.
Tracking Expenses and Out-of-Pocket Costs
Monitoring your expenses and out-of-pocket costs is an essential part of managing your health care. It’s important to monitor your expenses to ensure that you are making the most of your Aetna chiropractic benefits and managing your budget effectively.
Aetna offers resources such as:
- The Aetna member website and Aetna Health app, which allow users to compare and shop for treatments, doctors, and hospitals based on estimated costs
- Cost-comparison tools for estimating and comparing costs related to office visits, tests, procedures, and surgery based on individual plans
- The Member Payment Estimator tool that takes into account deductibles and coinsurance to help users estimate their out-of-pocket expenses
These resources can provide health insurance help to Aetna members, enabling them to make informed decisions about their health insurance plans and manage their costs effectively.
The average cost of chiropractic services under Aetna insurance is influenced by the specific plan and coverage. Aetna Medicare Advantage plans usually cover 80% of the cost, leaving the patient responsible for the remaining 20%. This means patients may have to account for a portion of the expenses. Additionally, Aetna may cover all or a portion of the cost of chiropractic care when deemed medically necessary. It is important to check with Aetna and review your specific plan for more information on coverage and costs.
Finding a Qualified Chiropractor Accepting Aetna Insurance
Identifying a qualified chiropractor who accepts Aetna insurance can be a key step towards accessing quality care. This process may involve asking for referrals, utilizing online resources, and scheduling consultations or initial visits. By using a combination of these strategies, you can find a chiropractor that fits your needs and accepts your Aetna coverage.
Online resources can be particularly useful for finding in-network chiropractors. Websites such as Zocdoc and Doctor.com provide listings for in-network chiropractors that accept Aetna insurance. Additionally, you can verify a chiropractor’s Aetna coverage by logging into the Aetna website and using their find a doctor tool.
In addition to online resources, personal referrals can also be a valuable source of information. Seeking referrals from individuals like friends, family, or your primary care physician, who have had direct experiences with chiropractors that accept Aetna insurance, can guide you to reputable providers.
Asking for Referrals
Requesting referrals proves to be a highly effective method in finding a qualified chiropractor who accepts Aetna insurance. To request chiropractor referrals that accept Aetna insurance from your primary care physician, you can ask for a referral to specialists who are part of the Aetna provider network.
Referrals from family and friends can also be invaluable. The most effective way to seek chiropractor referrals from friends and family is to ask for their recommendations, as they may have personal experiences with chiropractors who accept Aetna insurance. In addition to being a dependable source of information, you do not need a referral from your primary care physician for chiropractic services covered under your Aetna plan.
By combining professional referrals with personal recommendations, you can compile a list of potential chiropractors and make an informed decision based on their qualifications, experience, and acceptance of Aetna insurance.
The internet serves as a valuable resource in finding chiropractors who accept Aetna insurance. Aetna’s provider directory serves as a tool for Aetna members to locate healthcare providers such as doctors, dentists, and hospitals that accept their plan. Non-members can also utilize the directory by specifying the type of plan they have. The directory simplifies the process of finding in-network chiropractors in a specific area.
You can also schedule appointments with in-network chiropractors online through your Aetna account. This ability to locate and connect with in-network chiropractors improves accessibility and convenience.
In addition to Aetna’s provider directory, websites such as Zocdoc and Doctor.com also provide listings for in-network chiropractors that accept Aetna insurance. Using these resources can help you quickly and efficiently find a qualified chiropractor who accepts your Aetna insurance.
Consultations and Initial Visits
Once potential chiropractors are identified, scheduling consultations or initial visits becomes a vital next step. Aetna’s chiropractic coverage includes initial visits and consultations for chiropractic care. These appointments can help you discuss your needs, ask questions, and gauge the chiropractor’s responsiveness and demeanor.
During an initial visit, your chiropractor typically discusses your overall health, performs a physical exam, reviews your medical history, and discusses treatment options. Depending on the situation, it may also involve X-rays and an adjustment. This comprehensive approach allows your chiropractor to develop a personalized treatment plan that aligns with your health needs.
The average cost of a chiropractic consultation and initial visit with Aetna insurance may vary depending on the policy and employer. It is recommended to check with Aetna directly or with the chosen chiropractic provider to ascertain the specific coverage and associated costs. By conducting consultations and initial visits, you can ensure you’re selecting the chiropractor that best fits your needs and situation.
Navigating the specifics of your chiropractic coverage with Aetna doesn’t have to be a daunting task. By understanding the nuances of your coverage, identifying in-network providers, checking the preauthorization requirements, and being aware of additional services and their coverage, you can fully utilize your benefits and ensure your chiropractic care is covered.
Maximizing your benefits also involves engaging in preventive care and maintenance, tracking your expenses, and understanding your out-of-pocket costs. By taking these steps, you can ensure you’re making the most of your Aetna chiropractic benefits and managing your healthcare budget effectively.
Finally, finding a qualified chiropractor who accepts Aetna insurance can be a crucial step in accessing quality care. By asking for referrals, utilizing online resources, and scheduling consultations or initial visits, you can find a chiropractor that fits your needs and accepts your Aetna coverage. Armed with this knowledge, you can effectively navigate your chiropractic coverage and receive the care you need.
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Frequently Asked Questions
Should a 90 year old go to a chiropractor?
Yes, a 90-year-old can benefit from seeing a chiropractor to address aches and pains associated with old age. Regular visits can help improve their quality of life and mobility.
Does Tricare cover chiropractic care?
No, Tricare does not cover chiropractic care for most of its members. It is only covered for active duty servicemembers when recommended by their Primary Care Manager, with potential legislation to extend coverage to retirees, Reserve, and National Guard members.
What is considered a medically necessary chiropractic service under Aetna?
Aetna considers chiropractic services medically necessary based on documented improvement within a specific timeframe and the maximum therapeutic benefit achieved, as determined by a chiropractic physician. This means that coverage is contingent on the patient’s progress and reaching the full benefit from the treatment.
How can I find an in-network chiropractor who accepts Aetna insurance?
You can easily find an in-network chiropractor who accepts Aetna insurance by using the search tool on the Aetna website or by logging into your Aetna account. Alternatively, you can use platforms like Zocdoc and Doctor.com to find chiropractors that accept Aetna insurance.
Speak to the Professionals about Medigap Plans and Original Medicare
If you find understanding the benefits involved with Original Medicare and Medigap Plans challenging, you’re not alone. Whether it’s a Medigap plan, or you want to know more about Aetna coverage for Chiropractic Care, we can help. Call our team at 1-888-891-0229 for a free consultation or complete the contact form on this site, and an expert will call you back at a convenient time.
We have decades of experience advising our clients on the complexities of Medicare and Medigap plans, the benefits, cost and deductibles. We’ll ensure you get the best rate in your state and advice you can trust.
Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.