I get asked a lot of questions about insurance in general… so I’ve decided to dedicate a blog post to it. Whether you have an HMO plan, or a PPO plan, hopefully I can answer some questions you may have.
Do Chiropractors Take Insurance?
For whatever reason, the general public believes that most insurance companies don’t cover Chiropractic services. This is not true, at all. MOST insurance companies cover our services. However, some plans don’t pay enough for it to make sense for a Chiropractor to accept the insurance (more on this later).
What is a Deductible?
In short, a deductible is the amount of money you need to spend before the insurance company begins to pay their portion. For example: if you have a $1,000 deductible, you must spend $1,000 before the Chiropractor starts getting paid by your insurance company. This is what we’re talking about when you hear “your deductible has/has not been met”. There are numerous ways around this, so make sure to ask your Chiropractor what your options are.
What is a Co-Pay?
This is the amount of money you need to pay the Chiropractor after each treatment. For example: a $15 co-pay means that after you get treated, you owe $15.
What the hell is Co-Insurance?
Co-insurance is tricky, so bare with me. Most insurance plans (after the deductible is met) will pay a PERCENTAGE of what the Chiropractor bills. Commonly, insurance companies might pay 60% of what is allowed for the treatment. The other 40%? That technically comes from you. That is what co-insurance is.
EXAMPLE: let’s say the insurance company will pay 60% of what is billed. This is also known as a 60% co-insurance plan, or a 60/40 plan. Let’s also say the Chiropractor billed out $100 to the insurance company. This means the insurance pays $60, and YOU will be responsible for the $40.
Again, there are ways around this. Every insurance plan is different, and most Chiropractors are willing to negotiate.
What is an HMO plan?
Also known as a “health maintenance organization” this type of plan that does not allow you to choose a Chiropractor you want to see UNLESS they are contracted with that HMO insurance company. The term “contracted” means that the Chiropractor has agreed to receive less money per patient, among other things, to be among the list of providers for that insurance plan. One big example is Kaiser Permanente. If you have Kaiser, and you want to use insurance. you can only go to a Chiropractor who is contracted with Kaiser.
We do not accept HMO plans at Clean Spine Chiropractic. Many Chiropractors don’t accept this insurance either. More on this later.
What is a PPO plan?
Also known as a “preferred provider organization”, this is the type of plan that allows you to choose any Chiropractor you want, regardless of whether or not they are contracted with that insurance company. Again, a big reason a Chiropractor WOULDN’T be contracted with an insurance company is because they would have to accept lower rates and deal with a lot more paperwork/hassle.
There are two types of PPO options: In-network and out-of-network.
In Network PPO Plans
These are PPO plans in which the Chiropractor is contracted with the PPO insurance company. These plans typically have a co-pay with a low deductible. These plans are also usually managed very closely by the insurance company meaning there’s more rules and regulations. There is also generally more paperwork involved.
Out of Network PPO Plans
These are PPO plans where the Chiropractor is NOT contracted with the insurance company. These plans typically have no co-pay, but usually have a higher deductible than in-network plans. They also include the co-insurance which was talked about earlier. These types of plans generally pay the Chiropractor more, and give us more freedom on what we can and cannot do with a patient. In short, there’s less rules.
I hope this helps someone out there! It didn’t help me 🙂