Insurance for Chiropractic Care

Did you know that there are all kinds of rules about how insurance for chiropractic works and is allowed to be used? Most of us think in terms of whether or not a procedure or treatment is covered but don’t realize the “reason” for this service is actually a big part of whether or not insurance pays.

Doctors are audited and fined for inappropriate insurance billing all of the time and it is common practice for insurance companies to issue payments and months later overturn the decision and hold funds from later bills. This is a nightmare for private offices to keep up with and often requires an employee whose sole job is to stay up on all the insurance bills that are going out and being paid, or not being paid! The more employees required for an office to run, the more expensive your health care.

Most of our medical insurance coverage is designed to treat specific medical conditions. When it comes to chiropractic, the medical conditions we tend to “treat” are those related to accidents, injuries or chronic pain. But wait a second, chiropractors first and foremost treat subluxations, that big term for spinal dysfunction and all the ways is affects communication from your body to your brain and vice versa.

That’s right, medical insurance is not typically designed to cover the kind of chiropractic care received in a family wellness office and billing for it can be deemed fraudulent! When it comes to the law, I stay away from this game.

Did you also know that there are all kinds of laws on how we offer discounts as well as charge cash rates, especially if we contract with insurance? I can bill an insurance company a specific rate but receive a much lower reimbursement per our “contract agreement” but I can’t necessarily bill a cash patient that same low rate the insurance company is paying.

Yep! Welcome to the provider side of our insurance system…

If I contract with insurance companies I can only discount my rates for cash pay up to 15% of my BILLED rate which means cash pay clients, the ones that don’t have insurance coverage, sometimes pay double the amount that an insurance company is paying a provider for the same care. NOPE! I also won’t play this game and actually feel pretty strongly it is incongruent and unethical.

According to the Washington State Insurance Commissioner, I am also not allowed to discount my care to a specific population. This means military discounts are illegal in our state! This also means sliding scales or other kinds of discounts are also illegal unless they are available to EVERY person that walks through my door. The only exception is for low-income/financial hardship discounts which have to be done through a very specific application and calculation process, not to mention the facility has to be approved by the state in order to offer it.

You can probably see the problems we face as private health care offices? You can probably see why health care is SO expensive and why so many doctors are turning away from it? I don’t like gray areas when it comes to the law and my ability to practice so I stick to ethical and congruent guidelines when serving ALL of my clients.

With rising co-pays and deductibles for most, a large community that doesn’t have chiropractic coverage anyways, a desire to serve young, growing families in my community who don’t have great PPO insurance or high family incomes, I choose to make my chiropractic practice simple and affordable.

This allows me to run my business at a lower cost, be accessible and care for those who most benefit from my specialty at an affordable rate, and focus more of my time and energy being a doctor instead of an insurance manager and business administrator. It even results in lower out-of-pocket costs for those with insurance because once those few visits are covered you are left with your remaining care at a very expensive rate.

This makes me happy and I hope it makes you happy too! Here’s to affordable, holistic, health care.

P.S. If you happen to have a great insurance plan, we are happy to provide you with a superbill so your insurance company can reimburse you the portion they would normally cover. This allows your chiropractic bills to go towards your deductible as well.