Chiropractic and Insurance
Health insurance pays for chiropractic care if it is a benefit included in your policy. Each policy is negotiated by either yourself or the Human Relations person in your office. If you aren’t happy with the terms of your policy, you need to let the HR person know so they know what to negotiate the next time around. Policies are one year in length, usually from January to December, but not always. You need to find out.
At the beginning of the “year”, you often will have to pay a “deductible”. This means that amount (as determined by your policy) is not payable by your policy provider and you will have to pay that amount out of pocket. However, you must make sure that whatever care you’ve gotten and have paid for is also billed to your policy holder so that they know about it and apply that amount to your deductible. If they don’t know about it, it won’t happen. Most of the time your health care provider will do that billing, but you should ask. You may have to get the information and provide it to your insurance company yourself. Once the deductible has been met, there are more options. You may have no co-pay (you’re the lucky one), a set co-pay, or a percentage, or both a set co-pay and a percentage. You might read your policy, but this is often confusing. You can also call your provider at the phone number on your ID card, but you will hear a message telling you that any information you receive may be incorrect, so remember that later if payment seems incorrect. For instance, the benefits may say something like: you have a co-pay of $15 and chiropractic care pays in-network at 80%. Interpreted, this means that if your doctor is a preferred provider (they have a contract with your provider), at the time of service you should pay the $15 co-pay and you may also be asked for an additional estimated payment of 20% of the payment amount or you may receive a bill later.
EOB (Explanation of Benefits)
It is highly unlikely that your insurance company will pay the amount that your doctor’s office bills, unless that amount is extremely low. So, the EOB (explanation of benefits) that you receive a copy of will show an “adjustment” or “contractual disallowment”. This is an amount that will not be paid by anyone. Healthcare providers are generally (as determined by your state‘s law) required to bill everyone that same amount. But they are paid according to your policy. The EOB shows the amount billed, the amount paid, and the co-payment due from you, the patient. Sometimes it shows the amount disallowed that the doctor’s office writes off. You may have been told by your policy provider that you only have a co-pay or that may have been what you understood (because it’s so confusing) and then not understand if you get an additional bill from your doctor’s office. If your insurance company shows on the EOB that you have an additional co-pay, you must pay it. Often, your policy will pay for chiropractic care for a provider even if they don’t have a contract with your company. The payment is generally lower and your portion higher, but this is an option also. There are some chiropractic offices that will not bill insurance. You may choose to get the care, then bill the company yourself. Call them and ask if you need special forms. Some providers may have you pay your portion of the bill at the time of service and others may wait to hear from the insurance company and then send you a bill. There is no rule for this. Each office may handle this differently.
Yes, it pays for chiropractic care. Correctly used and correctly documented, there is no limit to the care. Please don’t suffer needlessly. You can get care any time you are in any pain. Health coverage of any kind does not pay for preventative (palliative) chiropractic care. Many Medicare patients also have secondary insurance that covers all or most of their co-pays Depending on your state laws, work injuries may include chiropractic care. This varies widely, so check. If you hurt yourself at work, report it to your supervisor and check on your rights and benefits. Sometimes this may not be easy, like if your employer doesn’t understand the coverage or at least acts like they don’t. If your employer doesn’t help you, find the phone number online or in the phone book and call yourself and ask.
Auto accident injuries are covered by your auto policy. This one is more complicated. You must have Personal Injury Protection (PIP) as part of your policy. If you have an accident that is your fault and you are injured, your policy will pay for your care. If you have an accident that is caused by someone else and you are injured, your PIP will pay for your care and later will be reimbursed by the other person’s insurance if their policy covers injury care. If your auto coverage doesn’t pay or underpays, you may need an attorney to help you. Their job is to make sure your injuries are treated and paid for. Hire an attorney that specializes in auto injury cases. The goal is to return you to the condition you were in before the accident. Small accidents can cause serious injuries. Watch for signs of head injury like: headaches, extreme fatigue, neck pain, short-term memory loss, anger, crying, mood swings, inability to concentrate. This last one is important in determining injuries in children that were in the car. Watch for it. Many times people don’t think their children are injured if they don’t make the same complaints as adults. They won’t. If you’re injured, your children are probably injured also. Have them checked by a chiropractor. Get care as soon after the accident as possible. You will have a quicker and more complete recovery.
If you have pain or an injury, don’t let confusion stop you from getting the care you need. Ask the chiropractor’s office, call the insurance company yourself, ask the HR person at work. Don’t worry and don’t wait. Ask questions and get the care you need.