ACTIVE CARE: This care includes relief, correction and stabilization of condition. It requires frequent visits that reduce frequency as the patient improves. Active care would typically never exceed a 2-week gap between visits. A doctors-prescribed treatment plan is necessary during this care phase. This is the only type of care considered by the insurance industry to be “medically necessary” and potential covered under insurance benefits. In addition to chiropractic adjustments, treatment during this phase of care may require additional services such as therapeutic modalities as well as rehabilitate exercises. Depending on the insurance policy these may or may not be covered under insurance benefits.

WELLNESS CARE: This care is meant to prevent future relapses and maintain the condition achieved after active care has been completed. This care requires periodic check up visits in order to prevent future relapses and/or to maintain the health status achieved during active care. Wellness care visits are usually anywhere from 2 weeks to months between visits. Our Doctor’s usually recommend 1x/month for 12 months followed by an annual exam but these recommendations are subject to change depending on the patient. The insurance industry determines wellness/preventative chiropractic care to be “not medically necessary” and therefore does not cover these types of visits.

There are two different codes used for each kind of chiropractic care (Wellness or Active). We cannot bill an active treatment code for wellness treatment or vice versa.  For a doctor to bill insurance using a code that is different than the service that was provided would be fraud and our office would never participate in that practice.

Absolutely! There just need to be a documented, legitimate; new condition, new injury, exacerbation, or relapse of a past condition. A new examination must be performed in order to determine if an active treatment is necessary. If an active treatment is recommended then active care can be started again and continued as long as change and progress can be measured and documented. If the treatment plan is not followed for any reason then the patient would be discharged again to a wellness care. 

Medical Necessity is a term the insurance industry uses to define what services are covered by insurance and what services are not covered by the insurance. Health insurance companies provide coverage only for health-related services that they define or determine to be medically necessary. Insurance will not pay for health care services that they deem to be not medically necessary. We feel that chiropractic wellness care is very important, but when contracted with insurance companies, we choose to follow the insurance companies’ rules.

 Even if your insurance benefits say you have a certain number of chiropractic visits per year, those visits need to fall under an active treatment program prescribed by the chiropractor to be covered.