What chiropractic services are covered?
Each member's health benefit plan defines the type of chiropractic services covered, limited, and/or excluded. Therefore, members and their providers are encouraged to consult their benefit plan and member handbook to determine whether any specific limitations or exclusions for this service apply. Please note that although a service or supply is authorized, certified, or found to be medically necessary, this does not mean the service or supply will automatically be paid for or covered.
How does the member qualify for chiropractic coverage?
In order to qualify for chiropractic coverage, your patient must have a painful and acute muscular skeletal condition that is not life‑threatening. Further, any proposed services or procedures must not be inappropriate for the condition or outside the practitioners clinical scope of practice.
In general, what conditions typically do NOT qualify for chiropractic coverage?
• Services that are not medically necessary
• Services that are outside the practitioner's scope of practice
• Services that have not been proven effective
• Conditions or diseases where chiropractic treatment is contraindicated
• Investigational and/or experimental services or treatment
• Maintenance, Preventive or Wellness Care unless the member's plan provides such benefits
Does Palladian Muscular Skeletal Health have licensed chiropractors on staff?
Yes! Palladian employs Clinical Peer Reviewers (CPR) who hold unrestricted licenses and registrations to practice chiropractic. Each CPR has a minimum of five (5) years experience and has been appropriately trained in the principles, procedures, and standards of Palladian. CPRs are available to speak with practitioners during regular business hours to discuss the facts of a case. In addition, if an urgent situation exists regarding a member's treatment, Palladian's Clinical Director can be reached 24 hours per day.
How can I contact Palladian Muscular Skeletal Health?
Contact our Customer Service Department, Monday through Friday, between 8:30 am and 5:00 pm EST.
How do I know if my patient has coverage for physical or occupational therapy?
Contact Palladian's Customer Service Department to verify the patient's eligibility at the time of initial visit and prior to rendering services. Your patients can also check with their insurance carrier or member handbook to determine whether their benefit plan has any specific requirements, limitations or exclusions for therapy services.
What does my patient need in order to obtain therapy services?
Most health plans require the patient to obtain a written referral and/or prescription from a qualified provider. "Qualified providers" are defined by state and/or federal law, and may also be specified by the patient's health benefit plan. Patients should obtain necessary referrals and/or prescriptions prior to scheduling an appointment for therapy services. If the referral or prescription expires, the patient may be required to obtain a new one. Once all necessary information has been obtained, the treating therapist submits an appropriate claim to Palladian for approval and/or payment of therapy services.
In general, what conditions or services do NOT qualify for therapy coverage?
Services obtained without a valid referral or prescription
• Services that are not medically necessary
• Services outside the practitioner's scope of practice
• Services that have not been proven effective
• Conditions or diseases where therapy is contraindicated
• Investigational and /or experimental services or treatment
• Maintenance, Preventative or Wellness Care
Does Palladian have licensed therapists on staff?
Yes. Palladian employs Clinical Peer Reviewers (CPR) who hold unrestricted licenses and registrations to practice physical or occupational therapy. Each CPR has a minimum of five (5) years experience and has been appropriately trained in the principles, procedures, and standards of Palladian. Palladian's CPRs are available to speak with practitioners during regular business hours to discuss the facts of a case. In addition, if an urgent situation exists regarding a member's treatment, Palladian's Clinical Director can be reached 24 hours per day.
