Understanding Chiropractic Care and what Insurance Plans
typically cover.....
Phases of Care: Active/Corrective Care (Billable to Insurance)
Most people are introduced to chiropractic care because they have some problem or symptom that needs to be addressed. When a patient begins care with a specific concern, this care is considered a period of active treatment. During this phase, visits are more frequent and the goal is to change dysfunctional patterns that have likely been present for some time and get the patient feeling better.
What’s important to distinguish is the difference between FEELING better and FUNCTIONING better. When a body is functioning well, it has the ability to change and adapt to the stressors in our lives. It also allows the body to perform at its highest level and prevents us from injury, damage, and degeneration.
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Phases of Care: Maintenance/Wellness Care (Typically not billable to Insurance)
While the initial phase of care is to get you feeling better, ongoing care is focused on attaining the highest level of function possible and maintaining it. Our daily lives come with a myriad of factors that affect this function. Physical stressors range from sitting too much, not getting enough exercise, accidents and injuries, to poor diet and nutrition. Mental stressors may include work, relationships, finances, etc. Once you’re feeling and functioning better, ongoing wellness care helps maintain that function in the face of all of these factors.
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Wellness/Maintenance chiropractic care can be viewed as part of your preventative health care program, like regular exercise or teeth cleanings that prevent decay and cavities. Regular chiropractic care works to maintain proper function and prevent development of new injuries or symptoms. And just like regular car or home maintenance, wellness care aims to help you perform optimally & THRIVE for years to come.
Chiropractic Timeline of Care
Active/Relief Phase of Care
Corrective/Stabilization Care
Maintenance/Wellness Care
Patient presents with a New issue or flare up of previous issue. An initial evaluation is performed, possible X-Rays taken, Diagnosis made and a treatment plan recommended at a more frequent basis to help get the patient relief from any pain/discomfort they are experiencing. This also starts the process of setting goals in relation to improving limitations of Daily Activities of Living that may be affected by their condition. Spinal Adjustments, Therapeutic Modalities, Massage, TRT Softwave Treatments and Acupuncture may be recommended to assist in this phase of care. (*see above for what is billable to insurance.)
Once the patient has shown progress in the Active Phase of Care by improving any limitations, reducing their pain/discomfort and reaching their short term treatment goals, their Provider will reduce the frequency of visits, provide them an at home exercise/stretching program and continue to stabilize the progress that was made during the Active Phase of Care. Now that shorter term goals have hopefully been achieved from completing an Active Phase of care, we can focus on setting and achieving long term goals with shorter intervals of care.
Once you have reached a level where you are considered at the Maximum level of improvement compared to when you first came in during Active Care, your Provider will release you to Maintenance/Wellness Care. Some patients find continuing to come in on a monthly basis for spinal adjustments help prevent future flare ups of their condition and/or make any future recoveries from injury much quicker. Unless your benefits summary specifically states "Maintenance Chiropractic Care is covered", insurance does not cover this care and it would be paid out of pocket. We have very reasonable Maintenance Fees to help our patients be able to continue on their Wellness journey as affordably as possible.
Questions & Answers....
Q: But my insurance says it will cover a certain amount of visits per year or has unlimited visits?
A: Most insurance policies do provide a certain # of visits per period for a patient and occasionally "unlimited visits". But there is always a disclaimer that these visits need to be "Medically Necessary" to be covered. Since we are contracted with your insurance, we agree to abide by their coverage policies, which means once a patient is at a certain level of medical improvement, their care would no longer be considered Medically Necessary and the patient would need to be released to Maintenance/Wellness care and pay without their insurance involved. This determination is at the sole discretion of your Provider per their contract with your insurance.
Q: But the other Chiropractic office I went to let me come in for as long as I wanted and it was never an issue with my insurance?
A: After being in practice for over 20+ years, we realize there are some offices out there that choose to not follow their insurance contracts and let the patient dictate care. As much as we would love to allow patients to have regular never ending visits, knowing how good it makes them feel, we know this does not align with the contract we signed to only bill Medically Necessary services to your insurance. We will not risk loosing our insurance contracts by billing fraudulent services to them per a patient's request. Federal insurances like Medicare also risk fines and jail time for billing services knowing they aren't Medically Necessary. We will NEVER risk doing this and appreciate your understanding when it comes to being Health Insurance Providers.
Q: Can I come in and use my insurance for visits when I need to and not follow a recommended treatment plan. AKA....come in randomly when I need an adjustment?
A: Insurance companies require documentation to show the Medical Necessity for care. On an initial visit for an issue, paperwork is required, an evaluation is performed, goals set based on your functional limitations and a treatment plan tailored to your diagnosis. Follow up visits show and document that the care is helping and that it is still Medically Necessary and billable to insurance. If a patient doesn't follow the recommended treatment plan and there is no documentation to show continued care is necessary, then the insurance company will assume that the issue resolved. After a certain time has passed with no follow up visits, we will close out that issue as resolved. If you decide to come back in after that we will have to start the process all over again. If you are wanting to come in on an "As Needed Basis" we ask that you let us know ahead of time and we will recommend you to do Maintenance/Wellness care and avoid the unnecessary documentation requirements of your insurance. *New Patients to our office will require initial paperwork and an evaluation of medical history and any current complaints to properly assess and move forward with appropriate recommendations. A fee for that initial evaluation will be required even if it is decided to not bill your insurance and proceed as a Maintenance/Wellness patient.
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Insurance
Self-Pay
Other Coverage
We are providers for most insurance networks, which means you will receive your insurance company's discounted rate for choosing a preferred provider. Each insurance's chiropractic benefits and discounts are different. Here are a list of most Insurance's we are In-Network with:
Blue Cross Blue Shield
United Healthcare/UMR
Aetna
Cigna
Medicare/Medicare Advantage Plans
Medicaid
Humana
PHCS
Ambetter
Click here to request a quote for cost
with Insurance
Auto Accident:
Attorney Representation
At Fault Insurance Claim
Med-Pay Auto Claim
Injuries from Negligence:
Attorney Representation
At Fault Insurance Claim
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Veterans Community Care Referral:
Must have VA approval before 1st Appointment which can be obtained by your VA PCP.
Our office also accepts these other types of insurance coverage:
Patients who have no Health Insurance or limited to no Chiropractic Benefits enjoy the cost savings provided by enrolling in ChiroHealth USA, a discount medical organization we contract with.
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By enrolling in ChiroHealth USA, we can legally offer you a 50% discount off of our cash prices. There is an enrollment fee of $49, which covers you and your immediate family for 1 year from date of enrollment. Please submit an inquiry for pricing by clicking here.
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