Office Policies

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Everyone's big question is "what will my insurance cover". That's a good question, and unfortunately, I can't give you the answer, because everyone’s insurance plan is different. Even people insured by the same employer can sometimes have different plans and different responsibilities within that plan. Until we know what the specifics of your plan are, everything is guesswork.

Here's my suggestion:
Call my office, and ask to speak to whoever is handling insurance billing. Give them your insurance information (it usually helps if you have the card in your hand when you call them) and they can find out what insurance benefits you have and let you know.

To help you understand, here is a quick outline of some of the words you might hear:

BENEFIT PERIOD: this is the amount of time that your insurance runs before it "resets" or "starts over". This is usually a year in length, and can start at any time. Most of the time, insurance plans start from January and runs through the end of December, or start in July and run through the end of June.  However, this could be completely random and is up to your insurance company.

DEDUCTIBLE: the amount you're responsible for paying for covered medical expenses before your health insurance plan begins to pay their portion of the cost. Not all insurance plans have a deductible, it simply depends on the individual plan.

COINSURANCE: this is where you and your health insurance plan share the cost of treatment. For example you may pay 20% of the cost and the plan pays 80%. Your plan may have a deductible that you have to meet before the coinsurance begins paying. Your plan may not have a coinsurance.

CO-PAY: this is an amount you pay each time you receive a service, and your insurance will cover the rest of the cost of that service. This is usually a fixed amount. This may start immediately, or you may have to meet your deductible amount first. Your plan may not have a co-pay requirement, or it may have a co-pay requirement that does not apply to the deductible.

Note: you will probably have either a coinsurance or a co-pay. From my experience, you will not have both.

OUT-OF-POCKET MAXIMUM: this is the maximum you will have to pay out of your own pocket for covered medical services. This includes your deductible, and after this point your insurance should cover 100% of covered medical expenses. However, this does not necessarily mean that your insurance company will cover everything after you have reached your out-of-pocket maximum. This is something you need to check with your insurance company. Your plan may have limits to the amount of a certain service that you can receive.

COVERED MEDICAL EXPENSES: your insurance plan will pay for what insurance company decides are "covered medical expenses". For example, some insurance plans that cover chiropractic treatment will not cover some of the modality therapies (ultrasound/electrical muscle stimulation/traction) that we may use during your treatment.

So a sample health plan may look like the following:

Deductible: $1000

Coinsurance: 20% (or maybe a co-pay at $30)

Out-Of-Pocket Maximum: $5000

This means you would be responsible for the first $1000 of your covered medical services. (Please note, that doesn't mean only chiropractic, that means of any covered medical services such as trips to your medical doctor, depending on what is covered). After that you would have a responsibility for 20% of the cost of your covered services, up to the point where you have paid $5000 during the benefit. Then your insurance will pay 100% up to any maximum policy limits.

A few thoughts on insurance:
One of the things I find that often occurs is that people seem to think that because they have "insurance" it means they don't have to pay anything, or that they do not have a responsibility to understand their insurance.

Please take a moment to try and understand your insurance. The insurance policy is a contract between you and an insurance company. We will bill your insurance company as a courtesy, but this by no means of absolves you of the responsibility of knowing what your policy is, and being aware of what you may have to pay. We will try to help you as much as possible, but the ultimate responsibility is yours.