Patients are often unsure if they need a referral prior to making an appointment with a Chiropractor. The short answer is: the majority of patients do not require a referral to see a Chiropractor because chiropractors are trained as portal-of-entry providers. The training includes differential diagnosis which enables Chiropractors to determine if the patient’s symptoms such as pain are related to the neurological or musculoskeletal systems or if the symptoms require further evaluation by another healthcare specialty.
An example of differential diagnosis would be numbness/tingling in the arm. Arm numbness/tingling could be related to irritation of a spinal nerve which would be in the scope of treatment of a Chiropractor; however, if the numbness/tingling is also associated with chest pain, an elevated heart rate, and/or elevated blood pressure, the possibility that a cardiovascular cause must be ruled out. If the symptom pattern points to a cardiovascular origin, the patient must be referred to a cardiologist or their primary care physician for further testing. The example illustrates the importance of performing an adequate history and physical examination prior to rendering treatment.
Now let’s get back to the original question of whether a patient requires a referral to see a chiropractor. Health insurance coverage can influence the answer to the question. Insurance providers are divided into two categories most often: PPO (preferred provider organization) and HMO (health maintenance organization). PPO insurances allow patients to visit healthcare providers and specialists without a referral (this includes chiropractors). HMO insurances require patients to get a referral from their primary care provider (gatekeeper) prior to seeing specialists (such as chiropractors). Medicare and Medicaid are government programs that do not require a referral. The Veteran’s Administration does require a referral to see a Chiropractor.
In conclusion, Chiropractors are portal-of-entry providers trained as specialists of the neuromusculoskeletal systems. Most insurances do not require a referral to see a Chiropractor (the primary exception is HMO plans).
If you have any questions about chiropractor referrals feel free to contact the office at 630-510-0080 or [email protected]
Yours in health,
Joshua Lederman, DC