–Filing with your insurance does not mean that your insurance will pay 100% for your services. For example, a new patient appointment in our office (as of 4/18/22) is $90 and includes your first treatment. With Medicare or Medicaid policies, you are always responsible for the examination fee – meaning you could pay a $20-$40 copay and still owe the full amount later. With other insurance policies, we usually see that somewhere between $25-$60 is applied towards your exam fee, so you’ll still owe what’s left. 100% coverage does happen, but it’s uncommon.

Medicare and Medicaid plans will pay 100% of your spinal adjustment fees and will not pay for anything else (so, for example, if you also needed soft tissue work or your knee needed an adjustment, 100% of that cost is on you). United Health Care, Blue Cross/Blue Shield, Aetna, etc. will usually pay between $15-$25 for adjustments and $5-$10 for cryotherapy, therapeutic exercise, cold laser therapies, etc. if billed from our office, but will typically pay more through patient reimbursement or direct filing through your patient portal.  

Chiropractic care, physical therapy, and some medical massage techniques are typically considered equal by most insurance plans. These services are also usually limited to 10-12 appointments per year depending on your insurance policy. A typical deductible is somewhere between $3,000-$6,000; this is the amount you pay out of pocket before an insurance provider will cover any expenses. Regular visits in our office are between $30-$60, so if your policy has 10 visits included in your plan that’s a maximum of $600 billed to your insurance. We would rather you save your insurance coverage for physical therapy services and/or massage services after a car accident or personal injury, which will help you reach your deductible faster and gain more coverage from your insurance provider. 

Another example. Let’s say you came to our office, paid your $40 co-pay, your visits were 90% covered, and you used all 12 of your allotted visits. Any visits after that are your responsibility, meaning you’ll still pay your $40 copay and potentially owe another $20 per visit until your deductible is met. And then, you’re in an accident on Rogers Ave, and you have no more coverage for Physical Therapy or acute chiropractic care for pain management. All of your care will be out of pocket, and you’ll still owe your monthly insurance premium. 

We do not bill your insurance directly, but all of our patient visits are documented according to Medicare and ICD-10 standards, meaning we can give you what’s called a “superbill” that has your diagnosis and treatment codes that insurance needs to process your claim. We would be glad to email this to you or print it for you while you’re in our office so you can file directly and be reimbursed by your carrier (and again, they typically pay you more than they would pay us!). If you ever need help navigating your insurance coverage, please don’t hesitate to ask.