Guide to Insurance
Many of our peers choose to run a cash practice in order to avoid working with insurance companies. We believe that you already pay a lot of money for your healthcare and we want you to get as much out of it as possible. We also believe that it is important for us to work within healthcare to change their policies to recognize the value of our services. Healthcare Insurance is a complicated world. We would like to think we know insurance plans in and out, but we are surprised everyday by them. As such, it is your responsibility to know and understand your insurance coverage and deductible amount. You will need to confirm your benefits prior to your appointment and understand how your insurance bills. We have done our best to provide more information about billing here. Here is some terminology that may greatly simplify things when trying to understand your insurance:
In-Network (IN) – This means that we have signed a contract with your insurance company and agree to charge our services based on their fee schedule
Fee Schedule – A list of services and how much an insurance company is willing to pay for those services.
Out-of-Network (OON) – This means that we have NOT signed a contract with your insurance company. This is either because they pay so poorly for our services that we refuse to contract with them or, more likely, they are not allowing anymore chiropractors to contract with them.
Deductible – This is how much you will need to pay before your insurance pays anything. You generally have a lower deductible for IN and a higher deductible OON.
Coinsurance – This means that your insurance will pay a certain percentage of the service and then you are responsible for the rest, even after you have met your deductible. They usually cover 80% for IN and 70% for OON. Please verify this with your insurance company.
Co-pay – Generally a small amount that you are required to pay for any visit to any provider
Chiropractic Benefits – If you have chiropractic benefits this means that you are ONLY covered for an exam and chiropractic manipulation. This does NOT include the movement therapy and soft tissue work that are a cornerstone of our treatment.
Physical Therapy Benefits – If you have physical therapy benefits this means you have coverage for movement therapy as well as soft tissue treatment.
CPT Code – A CPT code is a number that insurance companies use to label a treatment.
Unit – A unit is the amount of paid pieces being used. Generally speaking a unit is a 15 minute block of a treatment being provided. We usually spend 30 minutes on movement therapy each visit, so this would be consider two units. Often times you may have a limit on units available under your healthcare plan.
Below, we have included the most common CPT codes and units used for an average follow up treatment.
97110 – Therapeutic Exercise. 2 units.
97112 – Neuromuscular Reeducation. 2 units.
97530 – Therapeutic Activities. 2 units.
We use these codes interchangeably depending on your condition and treatment. These are a KEY component to treatment as our entire model of health is based on movement. Not all need to be covered but at least 1 does.
97140 – Manual Therapy/Soft Tissue Mobilization. 1 unit. This allows us to focus on treating muscles and ligaments that may be contributing to your symptoms.
98941 – Chiropractic Manipulative Therapy. 1 unit. This allows us to use traditional chiropractic treatment.