The first question patients may ask when they call into our office is usually “Do you accept my insurance?” With the affordable care act, everyone is required to have health insurance, so most people want to take advantage of a service for which they are already paying.
In our office, we are in network with Blue cross/Blue shield, Aetna, United, and Medicare. Insurance plans are usually categorized as PPO or HMO - and we only participate in PPO Plans. You can learn more about the difference between these two types of plans here.
What do you need to know to actually understand how much your visit will cost? Just a handful of details. First, you need to know your plan’s benefits. Second, you need to understand how medical services get billed. Lastly, you need to understand Insurance reimbursement policies.
So, let’s start with benefits. With the internet it becomes easier each year for patients and doctors alike to check an insurance plan’s benefits. It is important to understand your premium, deductible, out of pocket maximum, CoPays and CoInsurance rates. But getting a list of prices for those benefits is meaningless if you don’t understand what each term means, so check out our other blog post on that topic if you haven’t already. We go over these values and their definitions with every new patient.
Now that you know your plans benefit details, how do chiropractic offices and other healthcare facilities bill for their services? American healthcare uses a fee for service model. This means when a doctor performs a healthcare service, they bill the insurance and/or patient for that service. This means doctors, hospitals, and chiropractors get paid based on what they do, and how much of it they do for you. (This opens up several ethical dilemmas, but that may be a better topic for another blog post)
In our West Loop office, we perform anywhere from 1-4 services per visit. To learn more about our office's specific billing practice, you can visit our blog post on that specific topic >>here<<. The most common services performed in our office are patient exams, chiropractic adjustments, physical therapy, and manual therapy (such as myofascial release or dry needling).
Lastly, let’s talk rates. One thing that frustrates doctors and patients alike is that it is often impossible to determine with 100% accuracy how much a visit will cost and how much of a visit an insurance company will cover. The two main reasons for that are that 1) Your doctor/chiropractor doesn’t know exactly what services you will require until they understand your problem and have a plan to treat it, and 2) different plans have different negotiated rates with providers, which means even two people with the same insurance company might pay slightly different rates. You can learn more about it here.
Hopefully that helps you understand you health insurance plan. If you’ve still got questions, we’re always willing to help explain, especially when you received a bill you don’t understand. Please don’t hesitate to call in or stop by when you’re in the West Loop!