Chiropractic Insurance Reimbursement:
How to Submit an Out-of-Network Claim

If your chiropractor is not in-network with your insurance, you may still be eligible for reimbursement. Some providers assist patients by submitting claims on their behalf. If they do not, you can personally submit an out-of-network chiropractic claim after paying at the time of service. This guide will walk you through the process to help you get the most out of your benefits.

Step 1: Check Your Out-of-Network Chiropractic Benefits

If you have chosen a provider who is out-of-network with your plan, review your health insurance policy before your visit to confirm if it includes coverage for out-of-network chiropractic care. Key points to check:

• Coverage Eligibility – Not all plans cover out-of-network chiropractic visits, so verify this first if you wish to seek reimbursement.
• Deductibles & Reimbursement Rates – Find out how much of your visit cost is covered after you meet your deductible. Some out-of-network deductibles are quite high.
• Pre-Authorization Requirements – Some insurers require approval before you receive care.

Call your insurance provider or check your online member portal for details.

Step 2: Get a Superbill from Your Chiropractor

To submit an out-of-network claim for chiropractic services, you need an itemized receipt, called a superbill, which includes:

• Your name, date of birth, and insurance policy number
• Chiropractor’s name, address, NPI number, and Tax ID
• Diagnosis codes (ICD-10) to explain your condition
• Procedure codes (CPT) that describe the treatments received
• Total charges and proof of payment (if applicable)

Request this document after each visit to ensure accuracy.

Step 3: Fill Out Your Insurance Claim Form

If your insurance company requires a completed claim form, you can:

• Download it from your insurer’s website (e.g., UnitedHealthcare, Blue Cross Blue Shield)
• Fill it out accurately, matching all details from your superbill, or attach the superbill if this is allowed.
• Attach any required documents, such as receipts or authorization forms

Incomplete forms can delay your reimbursement, so double-check all fields.

Step 4: Submit Your Out-of-Network Chiropractic Claim

Confirm the process by calling the claims number on your insurance card. Depending on your insurer, you can submit your claim through:

• Online portal – Some companies allow digital submission for faster processing.
• Mail – Send a printed claim form and documents to the insurer’s claims department.
• Fax – Check if your insurer accepts faxed claims and get the correct number.

Always keep copies of everything you submit.

Step 5: Track Your Claim & Review Your Explanation of Benefits (EOB)

After submission, follow up to ensure your claim is processed:

• Monitor your claim status via your insurer’s online portal.
• Respond to any additional requests for information promptly.
• Review your Explanation of Benefits (EOB) for accuracy once the claim is processed.

Your EOB will detail how much was covered and your reimbursement amount.

Additional Tips for a Smooth Out-of-Network Claim Process

• File claims promptly – Most insurers have time limits (e.g., within 90-180 days of service).
• Know your patient responsibilities – Some plans cover a percentage of the cost, while others may require full payment.
• Ask your chiropractor’s office for assistance – They may provide billing support or help you complete forms correctly.

By following these steps, you can maximize your out-of-network chiropractic insurance reimbursement and make the claim process easier.