Insurance Can Be Tricky – But We’ve Got You Covered.
Insurance is confusing for many people, but don’t worry—we handle it for you. Once you’ve scheduled your appointment and completed your new patient paperwork online, our team will verify your benefits, explain your coverage, and let you know exactly what to expect with no surprises. We’re here to make the process easy so you can focus on getting better.
Insurance Terms
Insurance can be confusing. Let us help you. When you schedule your appointment we will have your insurance verified for you and printed out exactly what your portion is required. Don’t have insurance? That is not a problem we do have a time of service discount to make care affordable.
In-Network
In-network providers have an agreement with your insurance company to provide care at negotiated rates. Where your deductible, co-insurance, or co-payment will apply.
Out of Network
An out-of-network provider does not have a contract with your insurance company. And your deductible, co-insurance, or co-payment will apply differently.
What is a Deductible?
A deductible is the amount you must pay out of pocket before your insurance begins helping pay for care.
For example, if your deductible is $1,000, you must pay the first $1,000 of medical expenses before your insurance starts contributing.
Once the deductible is met, your insurance typically begins sharing the cost of care.
What is a Co-Payment?
A co-payment is the fixed amount you pay at the time of your visit.
For example, if your insurance plan has a $30 copay, you will pay $30 each time when you come in for your Chiropractic appointment, and your insurance company covers the rest according to your plan.
Copays are common for office visits and are usually the same amount each visit.
What is Co-Insurance?
Coinsurance is the percentage of the cost that you and your insurance company share after your deductible is met.
For example:
• Insurance pays 80%
• You pay 20%
If a chiropractic visit costs $100, your insurance would pay $80 and you would pay $20 each visit.
What Is a Pre-Authorization?
Pre-authorization means your insurance company must approve certain services before they are performed.
This ensures the treatment is considered medically necessary and eligible for coverage.
Not all chiropractic services require pre-authorization and only some insurance plans require this.
Is a Referral Needed to See Dr. Shelton?
Not usually but certain plans, especially some HMO or managed care plans, may require a referral from your primary care physician before Chiropractic treatment is covered.
If a referral is required, your primary care doctor simply provides authorization for Chiropractic evaluation and treatment.
What does “medical necessity” mean?
Medical necessity is a term insurance companies use to decide whether a treatment is required to diagnose, treat, or improve a specific health condition.
For Chiropractic care, this means the treatment must be intended to correct a documented problem and to improve function.
Common Insurance Questions Patients Ask
1. Does health insurance cover Chiropractic care?
Answer: Yes, most health insurance plans cover Chiropractic care at least partly—but it depends on your specific plan! Many plans pay for visits to help with back pain, neck pain, or headaches when a doctor says it’s needed (called “medically necessary”). Some plans cover it just like regular doctor visits, but others have rules. You can check plan details or call your insurance company to see if Chiropractic is included or when you have a scheduled appointment we will verify the coverage for you.
2. How many chiropractic visits does my insurance cover per year?
Answer: This is one of the top questions patients ask us! Most health insurance plans cover a limited number of Chiropractic visits per year—typically 5to 12 to 20 visits (some do not have a max visit limit!). A few plans use a dollar limit instead, like up to $500–$1,500 total for Chiropractic care annually. These limits usually reset each year (often January 1st or your plan’s anniversary date), and unused visits don’t carry over.
Once you’ve reached your covered visits or dollar cap, insurance generally stops paying, and additional care would be out-of-pocket. But we make this simple and stress-free at our office:
We verify your insurance benefits for you — right at the start — so you know exactly how many visits (or how much dollar amount) your plan covers for Chiropractic services like spinal adjustments.
Everything is put in writing before any charges occur. You’ll get a clear, written breakdown of your estimated coverage, any copays/deductibles/coinsurance, visit limits, and what happens if/when benefits run out. No surprises!
If you need ongoing care beyond what’s covered (for maintenance, wellness, or continued support), we offer a time-of-service discount to help make it more affordable. When you pay at the time of your visit (instead of billing insurance later), you receive a special reduced rate that offsets the lack of further coverage—saving you money while keeping care accessible and convenient.
To get your exact details, check your plan’s “summary of benefits” (look under “Chiropractic services,” “spinal manipulation,” or sometimes “physical therapy”), or let us handle the verification call or portal check for you—it’s one of the ways we help patients plan confidently. Knowing your limits upfront means you can focus on feeling better, whether through insurance-covered visits or our helpful discount for care.
3. Does insurance cover Chiropractic for maintenance or wellness visits, or only for pain/injuries?
Answer: Most insurance plans only cover Chiropractic care when it’s for a specific problem, like back pain after an injury or ongoing issues that need fixing (medically necessary). They usually do not cover “maintenance” or “wellness” visits just to keep feeling good or prevent future problems. Silly- we know! Because just like your car – if you maintain it, it is less likely to cause you long term problems. Medicare, for example, only covers spinal adjustments for certain back issues, not maintenance care. If your plan has limits, we will discuss them with you before any charges are incurred.
4. I got this from my insurance an Explanation of Benefits (EOB), and is it a bill?
After we submit your visits, your insurance company will send you a letter called an Explanation of Benefits (EOB).
Think of the EOB like a report card from your insurance company—it shows what doctor stuff happened, how much they paid for your Chiropractic visit, and your portion. It’s not a bill from our office (or anyone)! It’s just their way of explaining things to you. If you ever get one and have questions about what it means, what numbers are for, or anything at all—just give us a call. We’re happy to explain it in super simple words and help make sure everything matches up perfectly. No question is too small!
Have Questions or Need to Reach Us?
Have questions about your plan, chiropractic visits, coverage limits, copays, deductibles, medical necessity, EOBs (those letters from insurance that aren’t bills!), or anything else? Fill out the quick form below – we’ll verify your benefits once your have made an appointment, filled out your paperwork and will explain everything in simple terms, and send you a clear written summary before any charges happen. No pressure, just helpful answers!
You can reach us during office hours: Monday-Wednesday 9-6 and Thursday 9-12.