Insurance and Chiropractic Care – You have questions, we have answers. Insurance plans and their benefits are an endless moving target!
- If you do not have insurance, or your coverage is inadequate, please ask about our Time for Service fees. This may be a better alternative for you.
- If you are being treated as part of a personal injury or auto accident case, it is imperative that you let us know when you schedule your first visit.
- As with most providers, we do our best to keep up with the changing landscape of insurance. However, it is important to understand that the patient – not the insurance company – is ultimately responsible for any fees associated with treatment. Co-pays and deductibles are due when services are provided. It is the insurance company who decides what a patient is billed – not the provider.
- For up-to-date information on what your plan covers, please contact your insurance provider. If you need assistance with this, we would be happy to help when we can!
We Are a Participating Provider with the following Companies:
- Aetna – please note we do not participate with Aetna Better Health (Medicaid)
- Horizon Blue Cross / Blue Shield – please note we do not participate with NJ Family Care (Medicaid)
- Cigna
- Amerihealth
- Medicare
- Medicare Advantage PPO Plans (We do not bill to Advantage HMO plans)
For your convenience, we bill to limited plans on an Out of Network basis including United Healthcare and Oxford
There is more in-depth discussions about insurance happening on our blog.
Terms people often don’t know, but feel embarrassed to ask (please don’t ever feel embarrassed about insurance questions!)
Deductible – The total amount you are personally responsible for before your insurance company starts paying benefits. Typically, deductibles are calculated as your total healthcare spending among all eligible services. Not all plans have a deductible, and among those that do the amount varies from a few hundred to thousands of dollars. Any services that the insurance company determines as counting towards the deductible, the patient would be billed for.
Copay – For in network plans, the amount the patient pays per visit. The copay may or may not cover all of the patient’s obligation, depending on the plan.
Coinsurance – For plans that utilize this system, the insurance company determines (using their own formula) what the patient will pay for treatment. This amount is typically billed after the visit, as we don’t know what it is until after insurance processes the claim.
Patient Obligation – A fancy way of saying the amount the patient is to be billed for treatment. This is determined solely by the insurance company.
Limits – Many plans have limits on the number of chiropractic treatments that are covered per year. You can still continue treatment after this limit is reached, however the insurance company will not pay towards it. Insurance companies do not let us know a patient has passed their limit until it has already occurred, so it is in the patient’s best interest to keep track of this if that is a concern.
A note about claim processing- Claims for treatment are sent out on a weekly basis, and responses from the insurance companies are most often timely. There are, however, exceptions to this which more commonly occur in physical medicine (chiropractic care, physical therapy, occupational therapy, etc) than with other health providers. In these cases, a delay may occur because the insurance company is forwarding all physical medicine claims to an outside specialist for evaluation.
Our Promise: When further information about your treatment is requested by your insurance, we send it in a timely manner. We do everything possible on our end to get a response ASAP. If you ever find that your insurance company is not responding, please feel free to call our office. If we cannot obtain a direct answer from your insurance, we can guide you with what steps you may be able to take to get answers from them.
