INVESTING IN YOUR HEALTH

 

Your health insurance is an agreement between you and your insurance company. Our responsibility at Atrium Health Services is to provide you with the best possible chiropractic care, and your responsibility is payment for services rendered. We have no contractual agreement with your insurance company, and they have no obligation to pay us.

 

Payment is expected at time of service unless other arrangements have been made.

 

Insurance may or may not cover the cost of your treatment. Insurance only covers services deemed to be medically necessary. Each insurance company has its own definition of medically necessary for chiropractic care, but the CMS (Centers for Medicare and Medicaid Services) definition that many insurance companies use is:  “The patient must have a significant health problem in the form of a neuromuscular skeletal condition necessitating treatment, and the manipulative services rendered must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function.”

 

You must also reach your deductible before insurance will reimburse you for your treatment.  Any treatment considered not medically necessary will not apply toward your deductible.

 

Insurance companies can also decide how much they will pay for certain treatments regardless of the amount the doctor charges. Only this approved amount applies to your deductible, any additional charge may be considered a non-covered service.

 

Many patients seek treatment for other conditions that do not meet the definition of medically necessary, such as treatment for digestive problems or allergies. This would fall under the heading of chiropractic maintenance therapy.

 

Very few insurance policies pay for maintenance or supportive care, which also has a definition from CMS:

 

"Chiropractic maintenance therapy is not considered medically reasonable or necessary, and is therefore not payable. Maintenance therapy is a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive and not corrective in nature, the treatment is then considered maintenance therapy.”

  

Insurance carriers also evaluate the frequency of treatment on submitted claims. Chiropractic care for an acute medically necessary condition should begin with visits more frequently, perhaps twice a week, and as the condition improves the visits should be less frequent. When the patient visits continue at about once a month, then the insurer assumes that the treatment is supportive, at which time it is considered to be a non-covered service.

 

Many insurance policies have separate deductibles and reimbursement rates for in-network and out-of-network providers.

 

Preferred Providers are a limited number of providers who agree to lower fees to have access to the patients in a particular insurance plan. Most of the networks are closed, and even if a doctor wanted to accept the lower fees the contract offered, the doctor could not join a closed plan. If a doctor were to opt out of the plan or the carrier determines that usage of services is greater than the number of doctors in the plan, then the plan could accept new providers. We are currently an out-of-network provider in all plans.

 

If you have an HSA (Health Savings Account) or an FSA (Flexible Spending Account), you can use it to pay for your treatment, regardless of whether or not your policy considers it a covered or non-covered treatment.

 

Non-covered treatments do not apply to your deductible.

 

The chiropractic technique we employ, while it addresses the neuromusculosketetal conditions recognized as medically necessary, excels in what is not covered in that it “seeks to prevent disease, promote health and prolong and enhance the quality of life or maintain or prevent deterioration of a chronic condition.” Our goal is to not only correct neuromusculoskeletal conditions, but also to promote health and enhance the quality of life, so much of what we do my be considered a non-covered service by most insurers.

 
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