Insurance; Frequently Asked Questions…

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and answers to them…

insurance FAQs

Q. Are you “in-network” providers for BlueCross BlueShield insurance?

A. Yes.  Link to our BlueCross listing at BlueCross BlueShield

Q. May I use my automobile no-fault insurance for treatment of injuries sustained in an accident?

A. Yes. No-fault insurance laws allow you to choose any licensed provider for treatment of your injuries.  The provider does not have to be a part of any specific network.

Q. How many visits will my insurance cover in a year?

A. Some insurance companies put a limit on how many treatments a policy will cover/pay for in a year.  Visit limits may range from 12 to 24 depending on the insurance plan.  Many plans do not limit by the number of visits, but may limit the number of services or dollar amounts they are willing to pay.  If more visits are needed, insurance companies will sometimes grant patients more visits depending on their condition.

If you need more care than your policy allows and your company will not agree to pay for more, you have the option to pay out-of-pocket.  If that is the case, many offices have discounts for those paying cash at the time services are rendered.

Q. What is a participating provider?

A. A participating provider has a contract with your insurance company to accept the rates the insurance company sets for specific services.  When seeing a participating provider you will receive the highest benefits and the lowest out-of-pocket expenses possible with your policy, even if you have a high deductible plan.  

That said, it is sometimes worth using a provider who is not in your network (a non-participating provider).  Why?  You may have received a high recommendation from someone you trust for a specially skilled or “good personality” practitioner.  The extra cost to see someone “out-of-network” may be affordable or just worth the cost because of your special need.

Q. Are there things that may not be covered under insurance?

A. There are endless variations of benefits between policies, even within the same insurance company!  Most policies cover examinations.  Medicare will not cover exams or therapies.  Some insurance companies will only cover certain therapies.  For example, they may pay for electric muscle stimulation, but not soft tissue massage.

Your best strategy is to call your customer service representative at your insurance company (the number is usually listed on the back of your member card).  Ask the representative what your policy states for benefits and limitations for chiropractic care.  Take careful notes.

Q. What should I bring for my first visit?

A. If you have a BlueCross policy you should bring your insurance card to your first visit.  We will copy your card and verify insurance benefits at your first treatment.  If your treatments will go through your auto insurance please bring the policy number, claim number, claim address, and adjuster name and number.  If you have already hired an attorney please bring that information as well.  It is also a good idea to bring any X-ray or MRIreports that you have.

Q. Do I need a referral to see a chiropractor?

A. Typically no, but there are a few rare exceptions.  Some plans require “pre-certification” for your condition before they agree to pay for your care.  If you are not sure if you need a referral or that you may need to be “pre-certified”,  then it is a good idea to check with your insurance company before your first visit.

Q.What is a deductible?

A. A deductible is an amount that you will have to pay out of pocket for health care services before your insurance will pay anything.  For example: If your deductible is $500, and your responsibility for treatment cost is $50, the $50 is applied toward your deductible which then becomes $450.  Once you have accumulated $500 in health care service costs which you have paid for, your deductible has “been met” and insurance pays 100% (unless you have a co-insurance responsibility for that service).  Health insurance plans with deductibles usually cost less than policies without them.

Deductibles can be set for a calendar year or a policy year.  Some may have a “carry-over” in which you have a month or two or three into the next year before having to meet a new deductible again.

Q. What is a Co-Insurance?

A. Some policies may not pay for a service at 100%, but only at 80%.  This means you will pay the leftover amount insurance does not pay.  Co-insurance amounts are based on your particular policy.

Q. What is a Co-payment?

A. A co-payment is a payment that you pay at the time of your service, which goes toward the coverage of your treatment that day.  It is paid on every visit.