Gone are the days where most people have a simple copay to see a doctor and the rest is covered. The new normal is high deductibles and restricted plans, meaning more patient expense and less insurance coverage. How much do you know about your plan?
Take a look at common insurance concerns and how they are addressed:
#1: It’s not “health” insurance—it’s “sickness” insurance. In other words, insurance is not designed to pay to keep you healthy. It only covers sickness and disease. It may surprise you to hear that Medicare specifically states: “Care that seeks to prevent disease, promote health, and prolong and enhance the quality of life, is not considered medically necessary.” (Medicare Carrier Manual section 2251.3)
#2: Documentation is required for your insurance to pay for care. Again, insurance will
NOT pay for maintenance care, wellness care, lifestyle care, etc. It will only cover active care during which you are experiencing pain, symptoms or other conditions. If your documentation indicates that your problem is “staying the same,” your insurance company may conclude that you have either reached maximum improvement and will no longer cover your care, or that the care you are receiving is not working and will no longer cover your care.
When answering questions, please consider how your condition affects you and your life throughout the week, not just based on how you feel when you arrive to our office. This information enables us to provide a clear rationale to your insurance explaining why your care should be covered.
We will do our best to help you take advantage of your policy benefits, but require your help in accurate and complete documentation. It is critical that you inform us of any new injuries, accidents or flare-ups immediately. Examinations and x-rays enable us to document your need for care.
#3: Insurance is not a free ride. Your insurance policy usually requires you to pay a deductible, co-payments, co-insurance and non-covered services. There are clear regulations that health care providers may not waive the patient responsibility portion. Doing so violates inducement laws, so please do not ask us to break the law.
#4: Insurance is like having a coupon. It’s designed to pay for a portion of your care; the rest is up to you. You can invest in your health now by continuing with lifestyle chiropractic care after your insurance benefits are exhausted, or you can quit care and potentially incur much more expensive health intervention procedures later. For example, spinal surgery costs typically range from $90,000-$150,000—imagine the out-of-pocket costs on that!
#5: Lifestyle choices are for keeping you healthy: chiropractic care, nutrition, exercise, rest and stress management. Lifestyle chiropractic care is focused on helping you add years to life and more life to your years. Regularly scheduled chiropractic checkups help you maintain a clear
brain-body connection which enables natural healing and optimal function.
Your health, now and for the future, is up to you.
Why do I need to fill out paperwork on every visit?
There is minimal paperwork required each visit in order to update us on your progress. These daily notes enable us to generate required documentation for your insurance company. Your input helps your insurance company to determine whether or not they continue to pay for your care, or if you become fully responsible for all charges. Please see #2 above for details.
How come I’m getting more bills from my insurance company?
You will receive Explanation of Benefits statements from your insurance company. Please be assured…these are NOT bills. They are merely statements that insurance companies provide so that you can review the services that were billed on your behalf. You are only responsible for paying your deductible, co-payments, co-insurance and services that exceed your insurance limitations on statements that come directly from our office.
What do I do if my insurance company sends me a request for information or questionnaire?
Some insurance companies will send you letters and/or forms for you to reply to or complete. You are required to comply with their requests for information within 10 days. Failure to do so will revoke your privilege of insurance assignment, and you will become responsible for all charges immediately. In addition, any correspondence that you receive must be brought to us so that we may have a copy of it for our records. In general, requiring you to submit information is merely a stall tactic for delaying payment to providers. You do need to respond to their inquiry to avoid unnecessary out-of-pocket costs due to erroneous rejections. However, please be careful, as some insurance companies misconstrue your answers in order to deny you coverage.
What do I do if I receive a payment from the insurance company or an attorney?
You are responsible to endorse and remit the check directly to this office within three (3) days of receipt, provided that we have accepted assignment of benefits. When sending any insurance payments to our office, be sure to include any documentation or check stubs that arrived with the payment.
What if I get new insurance or if my insurance was changed or cancelled?
Please notify our office immediately. New coverage may save you out-of-pocket costs. Notification of a cancellation or change in benefits will help you avoid bills for unexpected charges later.
What is a deductible?
The amount your insurance expects you to pay each year. Your insurance company actually “deducts” this amount from the doctor’s payment before paying any claims. It is illegal for a provider to waive your deductible.
What is a co-payment?
The amount your insurance expects you to pay each visit. Sometimes a co-payment is a flat fee; sometimes it is a percentage. It is illegal for a provider to waive your co-payments.
What if I have other questions about my insurance coverage?
Just ask our “insurance expert” Alicia, the Office Manager for Hart Chiropractic.