Health insurance helps to pay for everything from visits to the doctor to prescriptions. However, not all health insurance plans are created equally. In fact, they can vary wildly, differing on everything from how much your co-pay will be, to whether office visits to a specialist are covered without a referral from your primary care physician.
Navigating the world of insurance can be downright confusing. We’ll break it down so that hopefully when you need to find a chiropractor for treatment, you’ll know what to expect.
First, Ask the Experts – Your Insurance Company!
If you aren’t sure if your health insurance covers chiropractic treatments, it’s a good idea to call your insurance company before you seek treatment. When you call, here are some of the questions you might want to ask:
- Does my plan cover chiropractic care?
- Do I need a referral from my doctor, or can I receive care from whichever chiropractor I choose?
- Is there a limit to the number of chiropractic visits I can schedule in a calendar year?
- Does my plan cover maintenance visits if I am being treated for ongoing wellness when I have no pain?
- Is the chiropractor I want to see considered in network or out of network for my plan?
- Will my visit be covered if my chiropractor is out of network?
- What will my co-pay be?
In some cases, your insurance company may tell you that they cannot guarantee coverage or payment until they receive and review a claim from your chiropractor. That means a few weeks after your appointment you will receive an explanation of benefits (EOB) from your insurance company. It will provide a breakdown of the care that was provided, the total cost of the visit, and the amount your insurance company paid. It will also let you know if there is any additional unpaid amount that you might be responsible for yourself.
How Much Will I Need to Pay?
In most cases, you will likely have a copay, coinsurance and / or deductible (or a combination of these) if you receive treatment from a chiropractor. That means you and your insurance company will likely split the bill.
Many health insurance plans work on the percentage system. That means your insurance provider agrees to pay for a certain percentage of an office visit, and you are responsible for the balance. For example, let’s say your balance for an appointment comes to $100, and you have an 80 / 20 plan. That means your insurance company will pay $80 toward your visit, and you would be responsible for the remaining $20 due.
If you have a high-deductible insurance plan, it may not provide coverage for any type of office visit until you have met your deductible. For example, if your deductible is $2,000, you would be responsible for any medical costs until you meet your plan’s deductible.
Finally, it’s important to remember that it’s often up to the insurance company to determine whether a particular treatment is considered medically necessary. Even if your doctor says it is, your insurance company may not agree. In that case, you can certainly still seek out whatever treatment you choose – it just means your insurance company may not agree to pay for it.
At Absolute Health Chiropractic and Massage, we do everything that we can to try to give you a clear picture of what your insurance will and will not cover ahead of time. We advise every patient to call their insurance company as well as it helps to minimize inconsistent information. Our goal is to take the worry out of finances so that you can focus on the big picture – optimal wellness.