I have insurance through work with Blue Cross. I checked with their customer service, and they told me my co-pay for chiropractic visits is $25, with up to 12 visits per year. My deductible is $350, and my out-of-pocket max is $5000. But when I went to a chiropractor that accepts BlueCross, they told me BlueCross said they wouldn’t cover the procedure. Has anyone else dealt with this issue?
Did they give a reason for not covering the procedure? Have you met your deductible yet?
Tom said:
Did they give a reason for not covering the procedure? Have you met your deductible yet?
No, I haven’t met my deductible. They said the chiropractic treatment wasn’t necessary, but it was recommended by my doctor after my knee surgery.
@Sage
In that case, you’ll need to meet your deductible first, and your doctor should appeal the decision if it’s being denied as not medically necessary.
Are they saying it’s not covered under your plan, or is it being denied for some other reason? There’s a difference between a chiropractic visit and a specific procedure.
Evans said:
Are they saying it’s not covered under your plan, or is it being denied for some other reason? There’s a difference between a chiropractic visit and a specific procedure.
The chiropractor’s office told me BlueCross said it wasn’t necessary to see a chiropractor after my knee surgery.
@Sage
Even covered procedures can be denied if they don’t meet the criteria for medical necessity. You should appeal the decision.
BlueCross is probably saying it’s not medically necessary or not proven to improve your recovery. You can request a medical necessity review.
You might want to call your insurance directly to confirm why it was denied. Were you referred to the chiropractor because of back pain?
Does your plan require prior authorization for chiropractic care?