Ah, insurance... The most thrilling topic to write about...
While this is definitely not my favorite topic in the whole world, it's an important topic to discuss, because the answer is not black-and-white.
What most people don't know about chiropractors is that in most states, their scope of practice can be rather wide. Depending on which chiropractor you go to, one might focus on functional neurology, the next might focus on posture, the next on rehab, and the next might mostly do functional medicine and focus on nutritional deficiencies.
That's an important distinction, because depending on what your goal of care is will change which type of chiropractor you'll want to go to.
And while chiropractors scope of practice may vary widely, in many states, what insurance pays for is typically pretty narrow. As a rule of thumb, if a chiropractor is treating you for pain, it is more likely that the insurance company will pay for care. But, if you're seeing a functional neurologist for a concussion or dizziness, like our friend Dr. Shem at Peak Brain Performance Centers, there is an increased chance that insurance will not cover some (or any) of your care.
Now, the next step is finding out whether or not the chiropractor chooses to deal with insurance companies. This factor also varies widely. More and more chiropractors are choosing to opt out of insurance and go for the cash-pay route. Why? Because chiropractic reimbursement rates have dropped more and more over the years, while costs of running a practice have not. In many clinics, there is often one administrative staff member (or more) who spends a majority of their time on the phone with insurance companies fighting claims that have been denied.
If you've found a chiropractor whom you love, but does not accept insurance, there still may be a way to get out-of-network reimbursement (if your plan covers that). Ask this practitioner if they can supply you with a superbill. A superbill is a detailed invoice that healthcare providers give to patients to document services provided during a visit. It will have the associated procedure codes and costs for those procedures so that it can be submitted it to your insurance company for reimbursement. This is what we do at Axon Health.
Another good thing to note? Even if insurance doesn't cover your treatment, it can still count towards your deductible. That is valuable information to know! You'll need a superbill for this too.
But, what about Medicare?
Ah... Medicare. An even more thrilling topic to write about.
Chiropractors are legally required to deal with Medicare in some capacity. Chiropractors are not allowed to opt-out of Medicare like medical doctors are.
For chiropractors, they can either be participating (par) or non-participating (non-par) with Medicare. The main difference between par and non-par providers is that par providers accept Medicare's approved amount as full payment for "covered procedures". Covered procedures for chiropractors is limited to the adjustment (in which case, the national average of reimbursement for this procedure sits around a whopping $28). This means your exam, possible x-rays, soft tissue work, rehab exercises, and, in the case of Axon Health, any travel fees, are not covered by Medicare. In contrast, non-par providers do not accept the approved amount as payment for "covered procedures".
Insurance can be daunting. If you still have questions about it, call our main line at 719-358-9460 and we can walk you through it!
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