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Insurance: How Does It Work?divider-grey-half

Insurance


▼What should I expect on my first visit?

While completing your intake forms with Priestley Family Chiropractic, you will be asked if you would like to submit your insurance. If the choice is to submit your insurance, then all insurance information will be gathered at the first visit. Your initial chiropractic consultation with the doctor is complimentary. Any further charges will be discussed with you before incurring. We do collect payment in full for services rendered on the 1st visit. Anything the insurance covers and pays for will be adjusted on your account.

▼How are claims submitted?

We will set up insurance billing for you and submit a claim for each visit. After the visit, a claim will be sent to your insurance company. The claim tells the company your diagnosis and the treatment received in our office.  The company processes this information and creates an “explanation of benefits” or an E.O.B. A copy of this explanation is sent to our office and to you.  The EOB tells both of us what amount the insurance company is paying Priestley Family Chiropractic for visits and the amount you are responsible for paying our office.

▼What happens if I unpaid or overpaid for my services?

Our billing department will enter the information into our computer and adjust your account accordingly.  Meaning, if you paid a $45.00 co-pay for your visit and it should have been $40.00, you will receive a credit of $5.00 for each visit overpaid.  The opposite is also true. If we charged $45.00 per visit and the co-pay was actually $50.00 you will be billed for the additional $5.00 per visit.

Insurance Terms


▼Deductible

This is the amount that must be paid out of pocket before your insurance will pay anything on a claim.  So for example, if you have a $300.00 deductible then you will pay $300.00 worth of bills to your Doctor(s) before your insurance pays anything.  After you have paid or “met” your deductible, your doctor visits will be subject to a co-pay, co-insurance, or may be paid completely by your insurance company. It all depends on your plan.

▼Co-pay

A set amount that you pay each time you go to the doctor.  The insurance company will pay the rest of the visit.  Sometimes there is a higher co-pay to see a specialist and a lower one when seeing your regular doctor.  For example:  You may pay $25.00 each time you go to your family doctor.  But you may pay $35.00 when you go to see the heart doctor.

▼Co-insurance

Co-insurance is a percentage of the bill that you pay yourself; the rest is paid by your insurance company.  So if there is a 20% co-insurance you will pay 20% of the charges for your visit and your insurance company will pay the other 80%.

Frequently Asked Questions


▼Can I use my HSA/FSA?

Most often, YES! Although each HSA/FSA can have their own specific rules, we will help you to interpret and use those benefits.

▼Can I go to an out of network provider, and why would I?

An out of network provider simply means a provider hasn’t signed a contract obliging them to the restrictions of the insurance company. Why this can beneficial to you, is that we are not constrained to the number of visits a year, which can limit the quality of care we can provide. We will be able to perform many complimentary procedures in clinic that if contracted, we would be forced to charge you for.

▼Can I submit on my own?

Absolutely! In our clinic, we pass along what we call an “admin/clerical discount”. That means we extend deeper savings to you when we don’t have to submit your claims. If you choose to submit on your own, we will print the necessary forms for you to send in.

▼What payment options do you have?

At the office, we provide an all up front option that gives the biggest discount, or a monthly or weekly payment option. We accept credit card, cash, checks, and Care Credit.

Myths About Insurance


▼I have insurance so they should pay for everything.

It is rare that an insurance plan will pay all of your medical bills.  Most often the company asks you to pay a portion of your medical visits either through co-insurance or co-pays or yearly deductibles.

▼The staff at Priestley Family Chiropractic should be able to tell me what my insurance plan covers.

It is your responsibility to know what your plan covers and what it does not cover.  You can call the number on your insurance card and ask them about your coverage at any time. As a courtesy to you, we can verify your benefits.

▼Contacting my insurance company for my benefits is too difficult.

It’s just a phone call or login away! You can call the number on your insurance card and ask them about your coverage or visit their website at any time. In reference to seeing the chiropractor, the questions you need to ask about your plan are the following: Does my plan cover chiropractic visits?  If so how many visits per year? Will I have to pay a deductible, co-pay or coinsurance on my chiropractic visits? (if you have a deductible to meet you should ask how much you have remaining)

▼If I have insurance I have to use it.

Some people choose not to use their insurance in our office.  Instead they are “self pay” patients. Self pay patients receive a discount for paying at the time of service.  For some people who have high deductibles this is better for them financially.

 

Your Rights As An Insured:

When you have insurance you have entered into a contract with an insurance company.  Every contract or plan is different even within the same company. Your insurance company will also have adjusted your plan based on your health.  For example, if you have a pre-existing condition then anything related to that condition will not be covered by your plan, even if it is a service that would normally be covered for anyone else on your plan. Every month someone pays your “premium”.  Your premium is that amount of money you pay for your insurance normally per month.  You could pay it yourself or perhaps your place of employment pays a portion for you.  You are purchasing a “plan” from the company.  It is important as a customer of an insurance company that you know what your plan does and does not cover.  That way you can make sure that they pay for services that they agreed to pay for and you are not surprised when they don’t pay for services they never agreed to cover. When asking for information about your plan you might have trouble understanding what is being said.  Terms like “subject to deductible”, “subject to co-pay”, “subject to co-insurance”, “in-network and out of network” and “maximum out of pocket” will be used to describe your coverage.  In reference to seeing the chiropractor the questions you need to ask about your plan are these:

  1. Does my plan cover chiropractic visits?  If so, how many visits per year?
  2. Will I have to pay a deductible, co-pay or coinsurance on my chiropractic visits? (if you have a deductible to meet, ask how much you have remaining)