While insurance is a confusing topic in itself… we hope this section clears the air for many of the most commonly asked billing questions.
- Advantra Freedom
- Aetna Health Plans
- American Specialty Health (ASHN)
- Blue Cross Blue Shield
- Berkshire Health Plans
- Capital Blue Cross
- Coventry Health Care
- First Health (Coventry Health Care)
- Geisinger Health Plan
- Golden Rule Insurance Co
- Highmark Blue Cross Blue Shield
- Horizon Blue Cross Blue Shield of New Jersey
- Independence Personal Choice (IBC)
- Medicare – All States
- Meritain Health
- Oxford Health Plans
- Railroad Medicare
- Tower Health
Out of Network Insurances
Please note… Our office is individually contracted with each insurance company. Each insurance company has a different set of fees they consider reasonable for the care provided. We do not determine these fees and will only know what the insurance company has paid once we receive payment. If the insurance company has paid for the service, they have already deemed it within the licensed practitioner’s scope to get reimbursed for those services. The Chiropractic profession has changed drastically over the last 30 years. Some offices stick to the basic adjustment during an office visit. However, we not only bill for the Chiropractic adjustment (98941 & 98943) but also physiotherapy items such as ultrasound (97035) electrical muscle stimulation (97032), myofascial release (97140) and more during a standard office visit. These therapies help add to the visit and overall reduce the amount of times a patient needs to be seen before their ailment is resolved. What may look like a higher amount than previous EOBs you’ve received from another Chiropractic office is in fact because our office does more during the visit. Should you have any questions or concerns about individual charges, please do not hesitate to call our office. Below is a list of common questions we hear from patients.
What is a co-pay or co-insurance?
A health insurance copayment is a fixed amount established by an insurance plan for sharing the cost of certain health services between the insurance plan and the insurance customer. Our office can fall under the (office visit) or (specialist) co-pay depending on which plan you have. We are required by our contractible agreement with the insurance company to collect the co-pay. It cannot be discounted, waived or changed.
A co-insurance is a percentage-based responsibility. Before anything is collected, our office will bill for the services and the insurance company will determine what the patient’s responsibility will be.
What is a deductible?
A health deductible is the amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After your deductible is met, your responsibility will only be a co-payment or co-insurance for covered services. Your insurance company pays the rest.
What does my insurance cover?
Each insurance plan is different. Some insurance plans will cover only the adjustment. Others will pay for therapies, medical massage and even acupuncture! Our staff will communicate what is and is not covered during your first appointment with us. Some insurances do not require prior authorization while others do. If prior authorization is needed, we might only get 3, 6 or 12 visits approved. We can always request more though. Please keep in mind that a zero Chiropractic deductible does not guarantee that the medical deductible will not come into play.
Why am I receiving a bill?
There are usually 4 reasons why you might receive a bill from our office.
- There is a deductible which has not been met for the year.
- You have a co-insurance that we did not collect during the time of service.
- The insurance denied the visits. In this case, we will do whatever we can to get approval.
- You do not have any more authorized visits for the year. Most insurance companies have a set number of visits allowed. This will reset each year though!
The EOB I just received says I owe something. It was explained to me that I wouldn’t have a charge outside my copayment.
Please keep in mind that you will receive this EOB before we get the charges back, so we might not have had a chance to reach out. Sometimes we get surprises from insurance companies where they do not cover a particular service that normally is covered under the policy. This is handled case by case as it sometimes does change what you would normally receive on an office visit. Some insurances also break up the Chiropractic deductible from the Medical deductible. We cannot determine this beforehand and will only know once payment is received.
Can I skip insurance and just go with the cash rate?
Yes! As mentioned earlier, sometimes we get surprised like denied services and hidden deductibles. We unfortunately cannot “haggle” with insurance companies nor make changes to how they handle Chiropractic claims. If it is more affordable to go with our cash rate, we can very easily make that change. If you happen to meet your deductible throughout the year and it now makes more sense to go through insurance, please let us know 🙂