Understanding your insurance can be confusing! Here are the basics to help you better understand your coverage for your chiropractic care.
Understanding Your Insurance
Number of Visits
The number of visits your policy will allow in a year. This does not mean they are paid for as the co-pay, deductible, co-insurance, and max out of pocket all still apply. Once the number of visits have been exceeded further treatment is not covered regardless the status of deductible etc.
Deductible
Individual
Dollar amount you pay for health services before your insurance company begins to pay. You still receive the discounted rate determined by your insurance company while the deductible is being met. If a family deductible has been met by other family members this individual deductible no longer applies. Co-insurance may apply once the deductible is met.
Family
Dollar amount your family has to pay before the insurance company begins to pay. This typically has to be met by more than one individual on the plan. Once met, everyone in the family is covered even if their individual deductibles are not met. Co-insurance may apply once the deductible is met.
Co-Pay
Fixed amount paid by the insured patient out of pocket for approved/covered services. This is per visit and typically does not apply to the deductible amount.
Co-Insurance
Once the deductible has been satisfied, this is the percentage you are responsible for of the covered services. This percentage is dictated by the patient contract with the insurance company. For example for a 80/20 plan after the deductible is met the patient is responsible for 20%. If the insurance approves or allows $100 the patient would be responsible for $20.
Out of Pocket Max
The maximum dollar amount you are required to pay out of pocket each year for services. This applies to the deductible and co-insurance. In a few cases the co-pay also falls under this. Once you meet the out of pocket max co-insurance is no longer required.
Frequently Asked Questions
Why did it take so long to get my bill?
There are many factors that play into this process. The way the insurance process works makes the whole billing cycle take a long time. Here are the process details:
The claim has to be sent out to the insurance company from our office, the insurance company then has to process it and send us an EOB (the insurance company has 30 days to respond), we then have to receive the response in the mail and process it, sometimes we then have to appeal the insurance company decision (up to another 30 days), then we have to send out a statement, depending on the timing of receiving the EOB in our billing cycle that can be another week or two. As you can see there a bunch of steps to get the statement to you, many of which are out of our control. We do our best to get statements out as soon as possible.
Why am I getting charged when I have X number of visits?
While each insurance has a specific number of allowed visits a year the deductible, copay, and co-insurance still apply. This number of visits is strictly how many times a patient can be treated and the charges be used towards a deductible or to be paid by insurance when the deductible is met.
Why doesn't my insurance cover anything?
We get this question a lot, and really it’s not that the insurance doesn’t cover the services provided, but that there is a deductible. When an insurance policy has a deductible this means the patient is required to cover all the charges until the deductible is met. During this time the charges are still discounted to the negotiated rate with the insurance company. Once the deductible is met the insurance company will start to pay for services.
I paid my co-pay, why am I getting a bill?
A copay is one portion of a patient responsibility, but there still may be deductible or co-insurance responsibility that will be billed after being sent to insurance.
Disclaimer
A quote of benefits does not guarantee payment or verify eligibility. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service.
Insurance benefits are determined by the contract the covered individual has with the insurance company. We file claims for you the patient with your insurance company as a courtesy. We do not have control of what the insurance pays or covers.