Active Care vs. Maintenance Care in Chiropractic Treatment
Understanding the Difference
When visiting a chiropractor, you may receive Active Care or Maintenance Care. Knowing the difference helps you make informed decisions about your health and to understand how insurance may cover your treatment.
What is Active Care in Chiropractic Treatment?
Active Care focuses on relieving pain, improving mobility, addressing functional loss, and addressing specific injuries or conditions. Chiropractors use this phase of treatment to restore function and help patients recover from discomfort caused by accidents, poor posture, or other musculoskeletal issues.
- Goal: Reduce pain and correct dysfunction
- Includes: Chiropractic adjustments, therapies, and rehabilitation exercises
- Insurance coverage: Often covered because it is “medically necessary”
- Treatment duration: Short-term, with visits decreasing as improvement occurs
What is Maintenance Care in Chiropractic Treatment?
Maintenance Care, sometimes referred to as wellness care, helps keep your spine healthy and prevents future problems. Once pain and dysfunction improve, regular chiropractic visits can maintain results and support long-term wellness.
- Goal: Prevent pain and maintain spinal health
- Includes: Periodic chiropractic adjustments and wellness visits
- Insurance coverage: Typically not covered because it is preventive or supportive
- Treatment duration: Ongoing, with visits scheduled monthly or as needed
Why Did My Insurance Cover My Care Last Month But Not This Month?
Many patients experience insurance coverage changes for chiropractic care. If your treatment was covered last month but not this month, here’s why:
- Transition from Active Care to Maintenance Care. Insurance covers Active Care because it treats a diagnosed condition. Once symptoms stabilize, further visits may shift to Maintenance Care, which most insurance plans do not cover.
- Policy coverage limits. Some insurance plans set a limit on the number of chiropractic visits per year. If you’ve reached that limit, coverage may stop.
- Claim coding differences. Chiropractors must use specific billing codes to document medical necessity. If a visit is classified as maintenance rather than corrective treatment, insurance may deny the claim. This is why maintenance care is not typically billed to insurance.
- Changes in your insurance plan. Policies can update their coverage terms, deductibles, or copay structures, affecting what they reimburse.
If you’re unsure why a visit wasn’t covered, check with your chiropractor’s office or contact your insurance provider for clarification.
Which Type of Care Do You Need?
If you’re in pain or recovering from an injury, Active Care may be right for you. If you want to maintain results and support your spinal health, Maintenance Care offers long-term benefits. Discuss your treatment plan with your chiropractor to ensure the best care for your needs.
