Navigating health insurance can be overwhelming—especially when it comes to chiropractic care. Terms like deductible, coinsurance, and medical necessity can make it hard to know what’s actually covered, how much you’ll owe, or whether your plan even includes the care you need.
At Bixby Knolls Wellness Center, we talk with patients every day about their insurance questions. Whether you're unsure about your benefits or just want to avoid unexpected costs, we're here to help you understand your options and make informed decisions.
In this guide, we’ll break down the basics of how insurance works for chiropractic care, from common terminology to coverage limits and how to verify your benefits. You’ll also learn what services are typically included, how we handle insurance at BKWC, and what to expect if we’re out of network with your plan.
Insurance in plain English
Health insurance is full of jargon, and if you’re not sure what it all means, you’re not alone. Below are a few of the most important terms to understand when it comes to using your insurance for chiropractic care.
Deductible
Your deductible is the amount you’re responsible for paying before your insurance benefits begin to kick in. For example, if your plan has a $1,000 deductible, you’ll pay out of pocket for covered services until you reach that amount. After that, your insurance may begin covering part or all of the cost of care.
It’s also worth noting that the amount you pay is based on your plan’s negotiated rate—not necessarily the provider’s full fee.
Annual limits
Some insurance plans include an annual limit on specific services like chiropractic care. This might be a maximum number of visits (e.g., 20 visits per year), a total dollar amount (e.g., $1,000 per year), or both.
Even if your plan says you have 30 visits, it may stop paying once you hit the dollar limit—regardless of how many visits remain. Always keep an eye on both numbers to avoid unexpected bills.
Copay
A copay is a fixed amount you pay for a specific type of visit or service—like $20 for a chiropractic appointment—regardless of how much the provider bills. This amount is usually due at the time of your visit and typically does not count toward your deductible.
Coinsurance
Coinsurance is the percentage of the total cost you’re responsible for after your deductible has been met. For example, if your insurance covers 80% of a visit, you would be responsible for the remaining 20%.
Out-of-pocket maximum
Your out-of-pocket maximum is the most you’ll be required to pay in a calendar year for covered services. Once you hit this number through deductibles, copays, and coinsurance, your insurance should (in theory) pay 100% of the remaining covered costs.
This only applies to services deemed eligible and medically necessary under your plan.
Medical necessity
Even if your plan says it includes chiropractic visits, your insurance provider still decides whether a visit qualifies as “medically necessary.” If it doesn’t meet their criteria—regardless of your symptoms or your provider’s recommendation—they can deny coverage. In many cases, documentation or notes are required for approval, and unfortunately, approval isn’t always guaranteed.
What chiropractic services are typically covered by insurance?
Coverage for chiropractic care can vary widely between insurance plans, but here’s what most patients can generally expect:
Spinal adjustments are commonly covered
In most plans that offer chiropractic benefits, spinal adjustments (also called spinal manipulations) are the core service that’s covered. These are the manual techniques chiropractors use to improve joint mobility, reduce nerve irritation, and support overall alignment.
Some plans include additional therapeutic services
Depending on your policy, you may also have coverage for supportive treatments such as:
- Muscle work or soft tissue therapy
- Kinesiology taping
- Examinations and re-examinations
- Corrective exercises or therapeutic modalities
Each plan is different, and some may require medical necessity documentation or have visit caps for these services.
Medicare has specific rules
If you’re using Medicare, it’s important to know that it only covers spinal manipulation to the back. This means you’ll be responsible for the cost of your initial exam, any re-exams, and treatments for extremities (like arms, legs, or jaw).
Supplemental Medicare plans cover your copay/coinsurance and may cover your deductible. A secondary insurance or a PPO Medicare plan may offer more coverage and flexibility.
How to find out what your plan covers
The best way to find out what your insurance plan covers is to call the Member Services number listed on the back of your insurance card. A representative can walk you through what chiropractic services are included in your plan, whether you have a deductible to meet, and if there are limits on visits or coverage amounts.
When you schedule your first appointment at Bixby Knolls Wellness Center, our team can also perform a courtesy benefits verification on your behalf. This means we’ll contact your insurance provider to confirm what’s covered and help you understand your potential out-of-pocket costs.
During the verification process, we’ll check for:
- Whether chiropractic care is included in your plan
- What services are eligible for coverage (e.g., adjustments, exams, therapies)
- Whether you’ve met your deductible
- Any copays, coinsurance, or visit limits that may apply
We’ll review this information with you before your first visit so you can make informed decisions about your care—no surprises.
What insurance plans do we accept?
At Bixby Knolls Wellness Center, we’re in-network with a range of major insurance providers, including:
- Anthem Blue Cross
- Aetna
- Blue Cross Blue Shield
- Blue Shield (except ILWU/CHPC plans)
- Landmark
- Medicare
- TriWest
- MultiPlan
- Select United Health Care and Optum plans
Keep in mind that even within these networks, not every plan includes chiropractic coverage. Some plans may cover only spinal adjustments, while others include a wider range of services. If you have a PPO plan not listed above, you may still have out-of-network benefits you can use.
We are out of network with the following Medicare Managed Care Primary Plans: Scan, Healthnet, AARP United Health Care Advantage, Cigna, Humana, Kaiser, and Optum. This does not pertain to supplemental plans, we accept all supplements to Medicare Part B.
What if we’re out of network with your plan?
If we’re not in network with your insurance, you may still be able to use your out-of-network benefits—especially if you have a PPO plan. Many PPO policies reimburse a portion of your care even when you see a provider outside their network. In these cases, you may pay up front at the time of service and then submit receipts to your insurance for partial reimbursement.
If your plan doesn’t include out-of-network coverage, don’t worry. We offer transparent, competitive self-pay rates so that you can still receive high-quality care without breaking the bank. We believe everyone deserves access to effective, personalized treatment—whether or not your insurance helps pay for it.
Using HSA, FSA, and other pre-tax benefits
If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can likely use those funds to pay for your chiropractic and massage therapy services at Bixby Knolls Wellness Center. Most of our services—including spinal adjustments, therapeutic massage, and mobility-focused treatments—qualify as eligible expenses under these pre-tax programs.
These accounts are a great way to reduce your out-of-pocket costs using money you’ve already set aside for health care. Just be sure to use your benefits before they expire—most FSA funds don’t roll over into the new year.
Here’s a quick checklist of what HSA/FSA dollars are commonly used for:
- Chiropractic adjustments
- Therapeutic massage (if prescribed for a medical condition)
- Mobility and rehabilitative services
- Initial exams and re-exams
- Supportive equipment (if recommended by your provider)
If you’re not sure whether your HSA or FSA can be used for a particular service, our front desk team can help guide you—or you can check with your plan administrator.
Final tips to avoid surprise bills
Insurance can be tricky, but a few proactive steps can help you stay informed and avoid unexpected charges:
- Always ask about your deductible and annual limits before starting care - Understanding how much you’ve paid toward your deductible and whether your plan has a cap on chiropractic benefits can help you plan ahead and prevent surprises.
- Keep an eye on how many visits you’ve used - Even if your plan allows 20 or 30 visits per year, some also have a dollar-amount limit. Tracking both helps you avoid hitting your cap without realizing it.
- Review your Explanation of Benefits (EOBs) - These documents, sent by your insurer after a claim is processed, show what was billed, what was covered, and what you may owe. Reviewing them regularly can help catch errors or gaps in coverage.
Still have insurance questions? We’re here to help…
Insurance shouldn’t be a barrier to getting the care you need. If you’re unsure about your benefits, coverage, or costs, just give our front desk a call. We’ll walk you step-by-step through everything.
You can also schedule an appointment to verify your benefits and discuss your treatment options with one of our providers. We’ll help you understand what’s covered and create a care plan that fits your goals and budget.
📞 Give us a call or fill out our online form to get started.
