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Cost of Care

Out-of-Pocket Cost: Your New Patient Initial Exam is ALWAYS an out-of-pocket cost regardless of if your deductible has been met.

Insurance Coverage Begins: Once your insurance begins reimbursement for your visits, we will determine your copay amount for future visits. Any amount that you may have overpaid from the visit date that your insurance began to cover a portion of, you will receive a credit on your account at our office that you can use for any follow-up care.

FSA/HSA Cards: Flex spending and health savings cards may be used at any visit.

Understanding Your Insurance:

Chiropractic Insurance: This refers to the extent to which your health insurance plan includes benefits for chiropractic care. It means that if you have chiropractic insurance coverage, your insurance provider will help pay for a portion of the costs associated with chiropractic treatments and services.

Review Your Specific Insurance Policy: We ask that you review your specific insurance policy or contact your insurance provider directly to fully understand your chiropractic insurance coverage. Some plans may offer full or partial coverage for chiropractic care, while others may have limitations or require you to meet certain criteria before coverage kicks in. As a reminder, your insurance policy is a contract between YOU and YOUR INSURANCE COMPANY. As a healthcare provider, we are not a part of that agreement.

Insurance Approval for Care: Some insurance plans may have a few requirements in order to approve coverage for care. Please verify with your insurance company if there are any requirements prior to them covering your chiropractic visits. These requirements may include the need to be “pre-approved,” to establish “medical necessity” with your primary, or they may simply have a limited number of visits that they’ll cover for the calendar year.

Are We In-Network With Your Insurance?

Medicare: We are in-network with Medicare (some plans – not linked to Kaiser or any HMO) and we accept with a secondary or supplemental as long a Medicare is the primary. We can send the billing for your visits. Medicare does not pay for the initial visit/exam and, in follow-up visits, will pay only for the spinal adjustment. Coverage does not include muscle work, extremity adjusting, ultrasound, laser, traction and any re-exams. These additional modalities would be an out-of-pocket cost.

PPOs: We are out of network with all PPOs. For some plans with out of network chiropractic coverage, we can send the billing for your visits. For all others, or your preference, we can provide you with statements to get reimbursed.

HMOs: We do not participate in any HMOs and HMOs do not have out of network chiropractic coverage.

Insurance Benefits Verification: Please verify your benefits with your insurance company. As a courtesy to you, we will also call and verify your benefits. Benefits ARE NOT a guarantee of coverage. We do our best to help you maximize your benefits with the information provided to us, but please bear in mind that what we are told over the phone and relay to you IS NOT a guarantee of coverage.

Getting Started with Verification: If you’re planning to utilize your Medicare or your PPO Out of Network Chiropractic Benefits, please send us a copy of the front and back of your insurance card prior to your first visit. We prefer to take care of all insurance questions prior to your visit to ensure you know what to expect for your portion of the payment. If you do not provide your insurance card ahead of time, we cannot guarantee a review of your benefits at your first appointment.

How Insurance Billing Works:

Billing Your Insurance: As a service to our patients, we will bill your Medicare or some PPO insurances. Billing your insurance is not a guarantee of coverage.

Providing Statements for Reimbursement: If you would prefer to submit your own statements to your insurance company, please notify us.

Patient Portion: Once we bill your insurance and they begin to cover a portion of your visits, then we will be able to determine what your copay will be versus full cost out-of-pocket.

Questions Regarding Insurance?
Call us at (408) 385-1849

Insurance | (408) 385-1849