How Much do you Know about Chiropractic Health Insurance?

Chiropractic Health Insurance

There are many benefits to receiving chiropractic care, but insurance is a confusing topic for many of my patients(and me on occasion!). The first things to understand are deductibles, copay’s, and coinsurance.  All of those are money you have to pay in addition to your monthly premiums before you receive care.  You must also recognize the difference between in and out of network.  This is enough to give anyone a headache.

Generally, if you visit an in-network doctor, you will be responsible for only your copay.  However, lately insurance companies are becoming excessively good at collecting high premiums and offering fewer benefits than ever. This means that you may have to pay a deductible of $100, $1000, or more before you have ANY coverage.  What is worse is that insurance companies will often count visits you paid towards your deductible as plan visits.  Here is an example:

Deductible $500; Copay $35; Limited to 12 visits/year
Lets say that 1 visit is about $50.  This means you will pay $50 out of pocket for the first 10 visits until you have met your deductible.  Great news! You insurance company will now cover the remaining two visits this year.  You pay $35 for two visits and the insurance company pays $15 for 2 visits.  Any more visits will be denied by the insurance company and you will have to pay the full $50.

The above example is all to common when it comes to Chiropractic Health Insurance coverage.  Coinsurance is common for out of network doctors and is sometimes cheaper than in-network if you have a low deductible.  Coinsurance means that you will pay 20% (or another percentage) of the total charge and the insurance company will pay 80%.

Signs of Good Chiropractic Health Insurance

Chiropractic Health Insurance

Photo used under Creative Commons from 401k

  • High number of allowed visits/year.  24 is good, but 60 is the best I have seen.
  • Low Deductible –  No deductible is the best deductible, how did we ever let insurance companies get away with charging us more than our already ridiculous premiums.  Your insurance will likely never be used with a deductible higher than $1000.  Even that would be hard to touch, shoot for only a couple hundred dollars.
  • Other benefits allowed such as ice/moist heat, muscle stimulation, massage, stretching, and exercises.  Many plans pay for “adjustments only”.

Important questions to ask about Health Insurance

  • Will “so and so” doctor be in-network?
  • How much will an in-network chiropractic visit cost?
  • Is there a deductible I have to meet for in or out of network visits?
  • Am I limited to a certain number of visits per year?
  • Do you cover only chiropractic adjustments or modalities such as stretching, ice/heat, massage too?

Are there alternatives?

Yes, there are many plans called Discount Medical Plan Organizations, or DMPO’s.  These DMPO’s offer a legal way for doctors to discount their services.  The unfortunate truth with is that doctor’s must have high fees because some plans pay that much.  If we billed lower they would only give us what we billed for and we must bill everyone without discrimination . . . Unless we have a contract.  DMPO’s let us cut our office fees down to a level suitable for uninsured or under-insured patients while still billing our usual and customary fee to insurance companies.

A chiropractic DMPO is ChiroHealthUSA.  They recently expanded their program to include several other services as well such as dental and optometry.  For less than $100 a year(<$0 a year for chiropractic only), you and all of your dependents can visit any ChiroHealthUSA provider (search for one on their website) for discounted chiropractic services.  Such a program is likely the closest thing you would ever find to true chiropractic health insurance.

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