State Insurance Regulations

Below you will find specific state regulations pertaining to chiropractic coverage. As the insurance industry changes, more and more insurers do business in multiple states. As penetration of different state markets occurs, state insurance regulations are sometimes overlooked. Be sure that the insurers in your state are operating in accordance with the regulations cited below. This information is also invaluable in adding strength to appeals to insurers and departments of insurance. Please review this information and include any pertinent statutes in your appeal. It is also helpful to review the information available from the Federation of Chiropractic Licensing Boards (FCLB) regarding state scopes of practice. Access FCLB's information here.

Please note: This material is provided for informational purposes only. The ACA does not officially endorse or suggest the enactment of any of the laws or regulations provided below. The ACA cannot provide legal advice or interpretations of state laws. If you need legal advice, please consult a qualified attorney.

To access your state's regulations pertaining to insurer recoupments, please click here.

Alabama

Reimbursement for services performed by an MD shall be reimbursed if performed by a DC if the service is within the DC’s scope of practice
Assignment of Benefits
Limitation periods for payment of claims; overdue claims; retroactive denials, adjustments
Requirements of utilization review agents
Patient right to know act

Alaska

Arizona

Arkansas

California

DCs certifications of disability
Injured workers right to chiropractic care
Prompt Payment of Claims

Colorado

Retroactive Adjustments of Claims
Prompt Payment of Claims
Network Adequacy Requirements

Connecticut

Coverage for chiropractic services requirement
Mandatory coverage for chiropractic services
Required Definition of Medical Necessity/External Appeal Regulations
Managed Care Accountability
Silent PPO Regulations
Prompt Payment of Claims

Delaware

Florida

Delegating services to chiropractic assistants
Chiropractic reimbursement in exclusive PPO's
Prompt Payment of Claims
Insurance Rates and Contracts (see item #4)
Silent PPO's, Assignment of Benefits, Overpayments

Georgia

Requirements for private review agents
Scope of Practice-including peer review definition
Prompt Payment of Claims

Illinois

Indiana

Employing Assistants (IC 25-10-1-13)
Delineation of individuals who can perform a manipulation (IC 10-1-14)
Right to communicate treatment options to patient outside of patient's insurance policy (IC 27-8-11-4.5)
Certifications for claims reviewers (IC 27-8-16-5.2)
Requirements for claims reviewers (IC 27-8-16-7)
Requirements for communications of appeals processes (IC 27-8-16-8)
Prompt Payment of Claims