Insurance and Chiropractic Care: How do I pay for My Care?
Insurance coverage can be confusing. Each company offers numerous plans under product labels such as PPO, HMO, POS, EPO, etc. Sometimes a plan offers chiropractic coverage but then excludes many of the services routinely offered by chiropractic doctors. There may also be limitations on the number of visits allowable per calendar year, and sometimes even on the number of therapies a doctor can provide on the same date of service. At our San Diego / La Jolla office, we do our best to help patients navigate the confusing world of health insurance which is ever changing and complex. Nobody wants an unexpected medical bill! We look out for the best interests of our patients and therefore we attempt to do our best to eliminate any surprises for you.
* Please note that the information contained in this section pertains specifically to coverage as it relates to our office. Your coverage may vary at other medical and/or chiropractic clinics.
* We try our best to get correct information from your health insurer but we do not guarantee benefits or coverage from any health insurance company.
No Insurance for Chiropractic Treatment
If you do not have insurance coverage for chiropractic care, don't worry! Our office has a special flat cash fee for patients who do not have chiropractic care as a benefit under their insurance plan. Please call our front office for more information about our cash rate. We are happy to give you an estimate of the cost of services.
Insured but High Deductible
These days it is not uncommon to see insurance plans with deductibles ranging from $2500 up to $10,000 or more. In many cases deductibles that high will not be met in a calendar year. If you have a high deductible, insurance companies will not cover any amount of treatment until you have met the deductible in full. This means that with a high deductible plan your benefits may never become accessible to you.
High deductible plans are best understood as insurance against catastrophic illness, since coverage does not kick-in until your medical bills, as defined by the contracted rate set by your insurance company, have exceeded your deductible. Although your plan may include coverage for chiropractic care, physical therapy, and other basic health services, most people with high deductible plans wind up having to pay out-of-pocket for these services. Why? Because their deductibles never get met in a calender year!
If you have a high deductible plan you may pay your bill at the contracted rate and our office can submit it to be applied toward your deductible. We also offer our patients with high deductible plans the option to pay their bill at our cash rate which is a flat fee. This flat (per visit) fee is often lower than the contracted rate set by the insurance company and may represent a considerable savings if you have a high deductible that you do not expect to meet in a calendar year.
Covered CA and Chiropractic Care (PPO's)
We are one of only a few in-network San Diego chiropractic offices with Covered CA. We can treat Covered CA patients who have PPO plans that were purchased through the government health exchange. Tthat includes the following plans offered in California:
Blue Shield of California: Bronze, Silver, Gold and Platinum PPO plans
Healthnet: Bronze, Silver, Gold, and Platinum PPO plans
* Please note that plans under Covered CA misleadingly allow you to believe that care provided by a doctor of Chiropractic is not a covered benefit. This is false as many of California's Essential Health Benefits are within the scope of practice for doctors of chiropractic to perform including evaluation and management exams, physiotherapy services, rehabilitative services, x-rays, durable medical products and wellness and prevention services. These services are covered for all patients with PPO plans purchased through Covered California as long as they are provided by a Covered California in-network chiropractic doctor. Dr. Berkoff is an in-network Covered CA provider. It is important to note that Covered CA plans do not include Chiropractic Manipulative Treatment as an essential health benefit, therefore that part of your treatment is considered to be a non-covered service. Should Dr. Berkoff determine that an adjustment /Chiropractic Manipulation is a essential to your course of care, we offer our Covered California patients a very affordable flat fee for this service. Call us for more information!
INSURANCE : Traditional PPO’s
If you have a PPO plan, once your yearly deductible is met, you will only be responsible for a copay or coinsurance percentage (copay and coinsurance costs vary and are determined by your specific plan).
The PPO plans our office accepts are:
Aetna
United Health Care
UMR
Healthnet (plans with out of network benefits)
Cigna (plans with out of network benefits )
Anthem Blue Cross (plans with out-of-network benefits)
Blue Shield
Humana ( plans with out-of-network benefits)
Other PPO's with out-of-network benefits
FSA's, HRA's, and HSA's
Our staff will happily prepare the necessary claims, statements and/or receipts needed for you to receive proper reimbursement from your Health Savings Account, Flexible Spending Account, or Health Reimbursement Account.
INSURANCE: HMO’s & EPO’s
As of July 1st, 2015 our office will no longer be in network with HMO or EPO plans with the exception of:
Aetna HMOs
United Health Care HMO through Optum health
*It is possible that you may also be responsible for paying for non covered services that may not be covered by your insurance plans. An example of this may be Premium Custom Orthotics and/or weight loss coaching.
MEDICARE :
We are on assignment with Medicare. Under Medicare, coverage for chiropractic treatment is limited to chiropractic manipulation treatment only. Chiropractic manipulation treatment is covered 100% by Medicare. However physiotherapy services such as traction, ultrasound, electrical stimulation, bracing, rehabilitation services, x-rays, durable medical product, wellness and preventions services, and all evaluation and management exams, are considered by Medicare as non-covered services and therefore, are the responsibility of the Medicare patient. Our office has special flat rates for evaluation and therapy services specifically for our patients with Medicare. Please let us know if you have a secondary insurance as this may cover some of these additional services.
TRICARE/ VAPC3 Chiropractic Care for Active Duty Military through Triwest:
We are proud to be one a few chiropractic clinics that accept Tricare. The VA has set up a Chiropractic network to provide care to Veterans through TriWest (VAPC3). The VAPC3 contract enhances access to health care services for Veterans by making a quality provider network available outside of the often overwhelmed Military hospitals and clinics. This contract ensures Veterans receive coordinated, high quality care in their community. We are approved to provide care to Veterans through this network. If you are an Active Duty Veteran ask your VA physician (PCP) for a referral to our office. We are ready and waiting for you!
WORKMEN’S COMPENSATION/ Chiropractic Care:
We accept Workman’s comp and will help coordinate care, claims, and approval of necessary visits.
MEDPAY (Auto Injury Insurance)
Patients who have been injured in an auto accident may have a provision in their Auto Insurance policy called MEDPAY. Medpay covers the medical payments of all passengers in your vehicle if they are injured in an accident. Med Pay will cover the medical costs resulting from an auto accident, regardless of who was at fault. Usually Medpay will have a per accident cap of around $5000 per passenger. Using your Medpay will not increase your insurance premiums and will ensure that your medical bills are completely covered. If you are unsure if you have medpay, please call our front desk, we are happy to help you find out. Every auto insurance allows for Medpay and our office accepts payment from all auto insurance companies.
EXCESS MEDPAY:
Under this type of Med-Pay, your car insurance carrier will only provide payments for medical bills you incur which your health insurance carrier does not cover. We will submit your claims to your health insurance first, and any out of pocket difference will be paid for by your excess med pay policy.
LIEN:
We accept Liens for Auto Injury cases that involve the assistance of an attorney to receive settlement.
THE AFFORDABLE CARE ACT and PREVENTATIVE HEALTH BENEFITS:
One of the most wonderful things coming out of the Affordable Care act is the inclusion of Wellness or Preventative Health Benefits which are not subject to copays or deductibles. Included in these benefits are diet and weight loss counseling if a screening exam shows you have a Body Mass Index equal to or greater than 30 or above. Our clinic offer two weight loss programs.
An example of what some plans offer:
-One face to face visit every week for the first month
-One face to face visit every other week for months 2-6
-One face to face visit every month for months 7-12
Many people are not aware they have preventative health benefits. If you have an insurance plan that that was purchased through the Covered Califonia Exchange network or if you are a member any group health plans created after March 23rd, 2010 , you must have preventative health benefits as mandated by law. Grandfathered plans ( plans in existence before March 23, 2010) do not have to include preventative benefits. The only way to know for certain if your plan includes these benefits is to call the number on the back of your insurance card and ask , “ Does my plan include preventative health benefits as mandated by the Affordable Care Act, does this include weight loss and diet counseling?”
Here is the link that lists all preventative benefits that are mandated under the Affordable Care Act (Obamacare).
https://www.healthcare.gov/preventive-care-benefits/adults/
Our office, feels that preventative medicine is a key factor in staying healthy so we encourage you to know about your benefits and use them to stay healthy!
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* Please note that the information contained in this section pertains specifically to coverage as it relates to our office. Your coverage may vary at other medical and/or chiropractic clinics.
* We try our best to get correct information from your health insurer but we do not guarantee benefits or coverage from any health insurance company.
No Insurance for Chiropractic Treatment
If you do not have insurance coverage for chiropractic care, don't worry! Our office has a special flat cash fee for patients who do not have chiropractic care as a benefit under their insurance plan. Please call our front office for more information about our cash rate. We are happy to give you an estimate of the cost of services.
Insured but High Deductible
These days it is not uncommon to see insurance plans with deductibles ranging from $2500 up to $10,000 or more. In many cases deductibles that high will not be met in a calendar year. If you have a high deductible, insurance companies will not cover any amount of treatment until you have met the deductible in full. This means that with a high deductible plan your benefits may never become accessible to you.
High deductible plans are best understood as insurance against catastrophic illness, since coverage does not kick-in until your medical bills, as defined by the contracted rate set by your insurance company, have exceeded your deductible. Although your plan may include coverage for chiropractic care, physical therapy, and other basic health services, most people with high deductible plans wind up having to pay out-of-pocket for these services. Why? Because their deductibles never get met in a calender year!
If you have a high deductible plan you may pay your bill at the contracted rate and our office can submit it to be applied toward your deductible. We also offer our patients with high deductible plans the option to pay their bill at our cash rate which is a flat fee. This flat (per visit) fee is often lower than the contracted rate set by the insurance company and may represent a considerable savings if you have a high deductible that you do not expect to meet in a calendar year.
Covered CA and Chiropractic Care (PPO's)
We are one of only a few in-network San Diego chiropractic offices with Covered CA. We can treat Covered CA patients who have PPO plans that were purchased through the government health exchange. Tthat includes the following plans offered in California:
Blue Shield of California: Bronze, Silver, Gold and Platinum PPO plans
Healthnet: Bronze, Silver, Gold, and Platinum PPO plans
* Please note that plans under Covered CA misleadingly allow you to believe that care provided by a doctor of Chiropractic is not a covered benefit. This is false as many of California's Essential Health Benefits are within the scope of practice for doctors of chiropractic to perform including evaluation and management exams, physiotherapy services, rehabilitative services, x-rays, durable medical products and wellness and prevention services. These services are covered for all patients with PPO plans purchased through Covered California as long as they are provided by a Covered California in-network chiropractic doctor. Dr. Berkoff is an in-network Covered CA provider. It is important to note that Covered CA plans do not include Chiropractic Manipulative Treatment as an essential health benefit, therefore that part of your treatment is considered to be a non-covered service. Should Dr. Berkoff determine that an adjustment /Chiropractic Manipulation is a essential to your course of care, we offer our Covered California patients a very affordable flat fee for this service. Call us for more information!
INSURANCE : Traditional PPO’s
If you have a PPO plan, once your yearly deductible is met, you will only be responsible for a copay or coinsurance percentage (copay and coinsurance costs vary and are determined by your specific plan).
The PPO plans our office accepts are:
Aetna
United Health Care
UMR
Healthnet (plans with out of network benefits)
Cigna (plans with out of network benefits )
Anthem Blue Cross (plans with out-of-network benefits)
Blue Shield
Humana ( plans with out-of-network benefits)
Other PPO's with out-of-network benefits
FSA's, HRA's, and HSA's
Our staff will happily prepare the necessary claims, statements and/or receipts needed for you to receive proper reimbursement from your Health Savings Account, Flexible Spending Account, or Health Reimbursement Account.
INSURANCE: HMO’s & EPO’s
As of July 1st, 2015 our office will no longer be in network with HMO or EPO plans with the exception of:
Aetna HMOs
United Health Care HMO through Optum health
*It is possible that you may also be responsible for paying for non covered services that may not be covered by your insurance plans. An example of this may be Premium Custom Orthotics and/or weight loss coaching.
MEDICARE :
We are on assignment with Medicare. Under Medicare, coverage for chiropractic treatment is limited to chiropractic manipulation treatment only. Chiropractic manipulation treatment is covered 100% by Medicare. However physiotherapy services such as traction, ultrasound, electrical stimulation, bracing, rehabilitation services, x-rays, durable medical product, wellness and preventions services, and all evaluation and management exams, are considered by Medicare as non-covered services and therefore, are the responsibility of the Medicare patient. Our office has special flat rates for evaluation and therapy services specifically for our patients with Medicare. Please let us know if you have a secondary insurance as this may cover some of these additional services.
TRICARE/ VAPC3 Chiropractic Care for Active Duty Military through Triwest:
We are proud to be one a few chiropractic clinics that accept Tricare. The VA has set up a Chiropractic network to provide care to Veterans through TriWest (VAPC3). The VAPC3 contract enhances access to health care services for Veterans by making a quality provider network available outside of the often overwhelmed Military hospitals and clinics. This contract ensures Veterans receive coordinated, high quality care in their community. We are approved to provide care to Veterans through this network. If you are an Active Duty Veteran ask your VA physician (PCP) for a referral to our office. We are ready and waiting for you!
WORKMEN’S COMPENSATION/ Chiropractic Care:
We accept Workman’s comp and will help coordinate care, claims, and approval of necessary visits.
MEDPAY (Auto Injury Insurance)
Patients who have been injured in an auto accident may have a provision in their Auto Insurance policy called MEDPAY. Medpay covers the medical payments of all passengers in your vehicle if they are injured in an accident. Med Pay will cover the medical costs resulting from an auto accident, regardless of who was at fault. Usually Medpay will have a per accident cap of around $5000 per passenger. Using your Medpay will not increase your insurance premiums and will ensure that your medical bills are completely covered. If you are unsure if you have medpay, please call our front desk, we are happy to help you find out. Every auto insurance allows for Medpay and our office accepts payment from all auto insurance companies.
EXCESS MEDPAY:
Under this type of Med-Pay, your car insurance carrier will only provide payments for medical bills you incur which your health insurance carrier does not cover. We will submit your claims to your health insurance first, and any out of pocket difference will be paid for by your excess med pay policy.
LIEN:
We accept Liens for Auto Injury cases that involve the assistance of an attorney to receive settlement.
THE AFFORDABLE CARE ACT and PREVENTATIVE HEALTH BENEFITS:
One of the most wonderful things coming out of the Affordable Care act is the inclusion of Wellness or Preventative Health Benefits which are not subject to copays or deductibles. Included in these benefits are diet and weight loss counseling if a screening exam shows you have a Body Mass Index equal to or greater than 30 or above. Our clinic offer two weight loss programs.
An example of what some plans offer:
-One face to face visit every week for the first month
-One face to face visit every other week for months 2-6
-One face to face visit every month for months 7-12
Many people are not aware they have preventative health benefits. If you have an insurance plan that that was purchased through the Covered Califonia Exchange network or if you are a member any group health plans created after March 23rd, 2010 , you must have preventative health benefits as mandated by law. Grandfathered plans ( plans in existence before March 23, 2010) do not have to include preventative benefits. The only way to know for certain if your plan includes these benefits is to call the number on the back of your insurance card and ask , “ Does my plan include preventative health benefits as mandated by the Affordable Care Act, does this include weight loss and diet counseling?”
Here is the link that lists all preventative benefits that are mandated under the Affordable Care Act (Obamacare).
https://www.healthcare.gov/preventive-care-benefits/adults/
Our office, feels that preventative medicine is a key factor in staying healthy so we encourage you to know about your benefits and use them to stay healthy!
c