insurance greenville nc

FAQ About Health Insurance

FAQ About Health Insurance

Corrective Chiropractic patients may have heard that the office will soon be joining the BCBS, Cigna, and Medcost networks. For many of our patients currently on wellness, this should not affect your current care plan, as most health insurance companies do not cover wellness.  You and others not currently covered by health insurance will continue to receive the same excellent care and flexible pricing structure that you are accustomed to.

To learn more about our payment options and wellness plans, please call the office directly.

 

For others, this news may be very exciting for you.  Although not every health insurance plan covers chiropractic, most do.  For patients who are experiencing headaches, neck pain, low back pain or other spinal conditions, insurance can be a valuable tool to help offset some of the initial costs associated with care.  And, while we encourage all patients to keep informed of their particular insurance policy guidelines, we will gladly verify your chiropractic coverage and file claims on your behalf.

If you do not see your insurance company listed below, Corrective Chiropractic may still be able to file as a courtesy, as a non-participating provider.

Corrective Chiropractic is so pleased to announce we are now in network with several of the largest providers of insurance nationwide, including:

  • Cigna Healthcare
  • HealthSpring
  • MedCost
  • HealthTeam Advantage (Care N’ Care)
  • Blue Cross Blue Shield of North Carolina (BCBSNC)
  • BCBS Advantage                       
  • BCBS Options
  • BCBS Care                                               
  • BCBS Choice
  • BCBS Select                                
  • NC State Employees Plan
  • Federal Employees Program (FEP)
  • All BCBS PPO Plans
  • All BCBS Out-of-State Plans
  • Blue Medicare Supplement Plans
  • UnitedHealthcare
  • UnitedHealthcare Medicare Solution
  • Health Allies
  • MAMSI
  • Signature Wellness Plan
  • UHOne 

 

 

 

How will this affect me?


Corrective Chiropractic patients that are under active care may see some changes in their current treatment plan.  These changes will be case by case and will be discussed with those affected individually.

And, as stated above, patients that are undergoing Supportive or Maintenance care should not be affected.  Most, if not all, insurance companies do not cover chiropractic care that is considered Supportive or Maintenance.

 

What exactly does that mean?

Health Insurance companies have “Medical Policy Guidelines” that are used during the adjudication process.  These guidelines are used to determine coverage and reimbursement for services. The definitions for Supportive or Maintenance Care can be found below.

Supportive Care:

  • is long-term treatment/care for patients who have reached maximum therapeutic benefit, but who fail to sustain benefit and progressively deteriorate when there are periodic trials of treatment withdrawal.
  • follows the appropriate application of active and passive care including rehabilitation and/or lifestyle modifications.
  • is appropriate when alternative care options, including home-based self-care or referral, have been considered and/or attempted.
  • may be inappropriate when it interferes with other appropriate primary care, or when the risk of supportive care outweighs its benefit, i.e. physician/treatment dependence, somatization, illness behavior or secondary gain.
                    

Preventive/Maintenance Care:

  • is elective healthcare that is typically long-term, by definition not therapeutically necessary but is provided at preferably regular intervals to prevent disease, prolong life, promote health and enhance the quality of life.
  • this care may be provided after maximum therapeutic improvement, without a trial of withdrawal of treatment, to prevent symptomatic deterioration or it may be initiated with patients without symptoms in order to promote health and to prevent future problems.
  • this care may incorporate screening/evaluation procedures designed to identify developing risks or problems that may pertain to the patient’s health status and give care/advice for these.
  • is considered care provided to optimize a patient’s health. Maintenance begins when the therapeutic goals of a treatment plan have been achieved and when no further functional progress is apparent or expected to occur.

 

**In simpler terms, “During Acute care, there is an expectation of significant improvement in both symptoms and objective findings from the doctor. This phase of care is generally covered if your plan has chiropractic benefits.
While, Supportive/Maintenance care, on the other hand, is care received once symptoms have either resolved, or the acute care phase has achieved its maximum effect (MMI), and the patient’s improvement has plateaued.”**

 

Does that mean that I don’t need chiropractic care?


Not at all.  Maintenance/Supportive care has long-term benefits for the patient. A patient may need on-going periodic adjustments once their condition has improved or stabilized to maintain the improvement that was achieved during the active care phase.

 

My insurance policy says that I have 30 visits per year.


Unfortunately, this can be misleading.  What that actually means is that your plan offers UP TO 30 visits per year based on medical necessity.  If those visits are used during an active treatment phase, it is likely that they will be covered. However, if those same visits are used on an “as needed” basis, and not under an active treatment plan, they are NOT GUARANTEED.

 

But I’m still hurting. Why won’t my insurance pay any more?


Remember that health insurance only covers care that it determines to be “medically necessary” based on their own medical policy. Generally, coverage will end once a patient reaches Maximum Medical Improvement (MMI).  MMI occurs when a patient with an illness or injury reaches a state where additional, objective, measurable improvement cannot reasonably be expected from additional treatment, and/or when a treatment plateau has been reached.

 

I started care while I had complaints, but now that I’m out of pain, what happens?


Insurance companies do not cover corrective, preventative, or wellness care. This unfortunate fact causes patients a great deal of frustration when they use their insurance to pay for care. Patients often expect the care their doctor recommends to be “covered”, so as a result of some chiropractors never give their patient’s recommendations for chiropractic care necessary but instead recommend only what insurance typical will pay for.  Corrective Chiropractic will always recommend what a patient truly needs to improve or correct their spine and their health. We follow ICA Best Practices not insurance guidelines.

We have several convenient payment options to help you get the care you need.  Of course, we accept cash, checks, and credit cards.  We also accept HSA/Flex, and Care Credit.  For more information, please contact the office directly.

 

 

Comments are closed.