More About Insurance Coverage
We like our patients to be aware of their insurance coverage for chiropractic care before being treated. The amount you will owe (co-pay, deductible, non-covered services) depends on your insurance coverage and the plan of care determined by Dr. John or Dr. Marna. Please call and check with your insurance prior to scheduling a visit so you are fully aware of what your coverage is for chiropractic treatment. We will also verify your insurance coverage, but it is not uncommon to receive incorrect information. Please see the list below on common insurances that we accept and bill.
Accepted Insurances:
Most Blue Cross Blue Shield plans*
Cigna
CBA Blue
All Worker’s Compensation carriers
All Auto or Personal Injury carriers
Medicare*
Not Currently Accepting:
Aetna
Medicaid/Green Mountain Care
MVP
United (we can bill to help meet your deductible, but your visit will be out-of-pocket)
Tricare (Tricare does not cover chiropractic services)
If your insurance is not listed, or you have further questions, please call the office for more information.
*A note about Medicare:
Medicare has limited coverage for chiropractic care. Medicare only covers “spinal manipulations”. This consists of manipulation (also known as an adjustment) to the neck, mid-back, lower back and pelvis.
In our office, we firmly believe that it may take multiple approaches to adequately heal or improve an injured body part; soft tissue work, neuromuscular reeducation, electrical stimulation therapy, ultrasound therapy, extremity adjustments, exercise prescription, etc. Any of these additional treatment options/interventions would be an out of pocket expense, ranging from an additional $16 to $100. Medicare also does not cover the initial consultation and evaluation (first appointment), which is $140.
Also, Medicare only covers for acute conditions or the stabilization for a chronic condition. A condition is “acute” when the patient is being treated for a new injury, identified by x-ray or physical exam, and can be expected that chiropractic treatment will improve or arrest deterioration of the condition. A condition is “chronic” when it is not expected to significantly improve or be resolved with further treatment. Medicare considers a condition to be chronic when it is not expected to significantly improve or be resolved, but chiropractic treatment can be reasonably expected to result in some degree of functional improvement. Once the chronic condition is stable and not expected to improve any further, additional treatment is considered “maintenance”, and is not covered by Medicare.
If you have a secondary insurance, (BCBS, AARP, etc.) please call and check what they cover as well. Many Medicare secondary insurances follow the same guidelines as Medicare, and thus will not cover anything that Medicare does not cover.
In summary, Medicare is a supplement to your total chiropractic treatment and can be helpful in offsetting some of the cost. It is very limited in the coverage and does not cover maintenance care. Chiropractic care can be very helpful for the conditions we see in seniors and it is unfortunate that the Medicare coverage is not more complete. The good news is that many of the non-covered services are reasonable and helpful, making the investment worth while.
*A note about Blue Cross Blue Shield:
Blue Cross Blue Shield, although generally covers Chiropractic care well, has some limitations to what they cover. If you have a BCBS plan, you generally have a maximum amount of visits per year, that if exceeded, must be paid out of pocket. The amount of visits can range from 12 per year, to unlimited. However, even though you may have anywhere from 12 visits to unlimited visits per year, each visit must meet a certain criteria in order to be billable to BCBS. Services that BCBS does not cover are below:
1. Treatment for a chronic condition when the therapeutic goals of a treatment plan have been achieved and no progress is apparent or expected to occur.
2. Maintenance/Preventative/Wellness Care – Defined as care in the absence of symptoms or care used to promote better health.
3. Treatment for “visceral conditions” ie. A condition that is not neuromusculoskeletal in nature.
4. Treatment for a covered condition after your maximum visit allowance has been reached, if prior approval is not obtained.
5. Supplies, medical equipment or supplements
6. Treatment solely intended to promote athletic achievements or a desired lifestyle or to increase/enhance the members environmental comfort
7. Any condition that BC/BS feels is not medically necessary. Sometimes we will not know this until bills have been submitted and responded to by BCBS.