Understanding Insurance and Financial Policies

Commonly, chiropractic benefits are included in your health insurance. Depending on your plan, you will pay a copay or coinsurance (a percent) for covered services and your deductible may apply. The best way to know is to call the customer service number on the back of your card and ask these questions:

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1. What are my chiropractic benefits?

2. How many visits per year? (Does my "year" start on January 1st?)

3. Do I have a copay or coinsurance?

4. Does my deductible apply? If so, how much of my deductible remains to be met?

 

WILL YOU FILE MY INSURANCE?

• Yes. We will file your insurance as a courtesy to you.

• Please understand that our relationship is with you, not your insurance company.  We are not a party to the contract between you and your insurance company.  As such, all charges are ultimately your responsibility from the date the services are rendered.

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ARE YOU A PROVIDER FOR MY INSURANCE?

1.     In general, we are providers for MOST Anthem, Humana, and Aetna contracts.

2.     We are NOT providers for United, Bluegrass, TriCare, Cigna, CareSource, Medicaid, or other plans.

3.     It is your responsibility to contact your insurance company to verify that any physician you see in this practice is a participating physician with your insurance company, and with your specific plan. To be certain that we are a provider for your plan, call the number on the back of your insurance card and ask for “Chiropractic Benefits” to verify.

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WHO IS RESPONSIBLE FOR KNOWING MY BENEFITS?

• We will also verify your benefits and explain them to you.  However, you are ultimately responsible for knowing your coverage.

• Not all services are a covered benefit in all contracts.  Some insurance companies arbitrarily select certain services they will not cover.  Certain policies have specific exclusions regarding what is and is not covered and WHO must perform the service. (also, see non-covered services tab)

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WHAT IF MY INSURANCE CHANGES?

• We must have your new information immediately.  Some policies have timely filing limits as small as 7 days.

• If you do not have an updated insurance card, you will be required to pay time-of-service.  No back billing can be accommodated.

• If we do not have your up-to-date insurance and timely filing has passed, you are responsible for the entire balance.

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MEDICAL NECESSITY

We are required to justify medical necessity for all treatment that is billed to insurance based on the chiropractic guidelines set forth by the individual insurance companies.

 

Medical necessity criteria varies by company but here are some general rules:

1. You must be under an active treatment plan with quantifiable, attainable goals for a certain number of treatments. 

2. Re-exams must be performed no more than every 30 days to continue care that is filed with insurance to show continual improvement.

 

NOT CONSIDERED MEDICAL NECESSITY BY INSURANCE

Although recommended for maintaining spinal health, the following are NOT considered medically necessary treatments for billing to insurance:

• Supportive care: long-term treatment for patients who have reached maximum therapeutic benefit but progressively deteriorate when there are periodic trials of treatment withdrawal.

• Preventative/Maintenance care: care that is typically long-term, but not necessary to treat a specific medical condition. Rather it is a treatment that would prevent symptomatic deterioration or promote health and prevent future problems.

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