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 prompt pay flat rate 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 per calendar year! In many cases deductibles that high will never be met. 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 prompt pay 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.
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 is in network with:
Aetna
United Health Care
UMR
Blue Shield
PPO's with out-of-network benefits( Anthem Blue Cross, Cigna, Healthnet)
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
Our office is no longer in network with most HMO or EPO plans with the exception of:
MPMG (with a referral and authorization from your primary care provider)
Aetna HMOs
United Health Care HMO through Optum health
Empire Plans through Optum
*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.
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.
* 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 prompt pay flat rate 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 per calendar year! In many cases deductibles that high will never be met. 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 prompt pay 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.
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 is in network with:
Aetna
United Health Care
UMR
Blue Shield
PPO's with out-of-network benefits( Anthem Blue Cross, Cigna, Healthnet)
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
Our office is no longer in network with most HMO or EPO plans with the exception of:
MPMG (with a referral and authorization from your primary care provider)
Aetna HMOs
United Health Care HMO through Optum health
Empire Plans through Optum
*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.
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.