Chiropractic and Insurance:

Top 5 health insurance myths when seeing a chiropractor.

• MYTH: In-network chiropractors are better than out-of-network chiropractors.

  • Becoming an In-network chiropractor for health insurance can be complicated but it’s not hard if you’re willing to give up most of your rights as a healthcare provider. While the insurance company cannot FORCE you to treat patients a certain way they can make a lot of requirements. These requirements make it difficult at best and impossible at worst (especially in North Carolina) to provide the care necessary AND be reimbursed for said medically necessary care.
  • Insurance will quickly STOP paying for chiropractic care as soon as the patient’s symptoms improve. This rarely happens if ever, with medical care. If you were to see this type of reimbursement happen for your medical services it would be similar to having insurance pay the emergency room care related to a heart attack. As soon as they got a sinus rhythm and put you in a different room you would be required to pay for ALL the other medical services out of your own pocket. This could easily cost tens of thousands of dollars.
  • As a result, many chiropractors have to make a choice between treating patients for what they need and requiring them to pay upfront. Then waiting for any potential insurance payments to be paid to them OR falling in line with what the insurance companies say they should be doing. Most chiropractors fit into the latter category. It’s easier to find patients and they are less likely to fail in practice which is something that happens VERY often in the chiropractic profession.

• MYTH: In network chiropractors are prescribing the chiropractic care necessary to CORRECT THE CAUSE of my problem.

  • Because of Myth #1, it is essentially impossible for chiropractors to get paid for the care necessary for corrective chiropractic care and be in network provider. Despite there being adequate research available to support the need for and benefit of structurally focused corrective chiropractic care, health insurance companies can put their fingers on the scale and make erroneous claims that only a few visits are necessary. Health Insurance does this on the principle that once the pain or symptoms have decreased by approximately 50%, no more care is necessary. There is little a small business chiropractor can do to stop it.
  • This underutilization of chiropractic is often a problem. In the 80’s chiropractors often OVER utilized and treated patients with nonspecific segmental adjustments, physical therapy or other modalities like heat, ice, STIM and Ultrasound that are not structurally corrective based treatments. This was done because during the 80’s health insurance would pay for ALL of the visits a patient’s insurance plan had (20, 30, 50, 70, etc.) for the year. There was no need to validate the care. As a result, many chiropractors used a lot of wellness or maintenance care while claiming it was essential to correction. Why? Because they were in network and your health insurance was paying. Don’t forget health insurance was originally designed for emergencies, not health and wellness. So, while those extra adjustments didn’t necessarily fix the cause of the problem they still often helped reduce the need for drugs and surgery.
  • Insurance understandably tightened down on reimbursements by the 90s. The problem now is for chiropractors who are structurally focused and able to validate the need for and are capable of providing Chiropractic Structural Correction, insurance isn’t won’t pay. They realized that they could easily avoid payments for necessary chiropractic care just as easily unnecessary chiropractic care. And since your health insurance company is responsible first and foremost to its shareholders… well, you can figure it out.
  • Because of the trend of poor insurance reimbursement for chiropractic, it is far more common to find structurally based chiropractors prescribing very specific and necessary care that are out of network instead of in network.
  • There are some, although very few, chiropractic offices like Corrective Chiropractic that are capable of prescribing and providing structurally focused chiropractic care. In order to do this, however, they almost always have to have the patients pay in advance for their care and then send a claim in as an out-of-network provider. Fortunately, this can be a good thing for the patient who is capable of doing this.

• MYTH: In network chiropractic care costs less.

  • Health insurance plans are often complicated and make it difficult to compare chiropractic healthcare costs. It’s like comparing apples to oranges. You can’t just compare a price tag for in-network chiropractic care vs out-of-network chiropractic care.
  • Often times, In-network and Out of Network benefits are comparable. Especially in cases where deductible and co-insurances apply.
  • When using an in-network provider, “non-covered” charges are still an out of pocket expense. So, either you will still have to pay, or you just won’t get those services. (So what if those services were necessary for correction)
  • Remember that your copays are not normally applied to your deductible or out of pocket expenses, so your copays regardless of how many you pay will never benefit you. On the other hand, by utilizing an out of network provider, the opportunity to meet your out of pocket and begin receiving reimbursement from your insurance company exists.

• MYTH: My insurance will NOT pay for out of network chiropractic care.

  • Insurance reimbursement for chiropractic care is based primarily on your insurance plan and company. Some insurance companies are very willing to pay for care as long as it’s within the patient’s plan. For example, if you have a plan with 30 chiropractic visits a year they will often reimburse you for all 30 visits once your deductible has been met, minus any co-pay that’s a part of your insurance plan. Other insurance companies, regardless of the plan you think you have, will fight tooth and nail to avoid paying for anything beyond 2 – 8 visits and often will refuse to pay for necessary services like x-rays or therapies.
  • It is true that some insurance plans seem like they will cost more because the deductible or copays for out of network chiropractic care is higher. Thankfully, it’s not uncommon for insurance companies to reimburse you for all of the visits on your plan without denying claims. This is not surprising because if they refuse to pay the bill for your out-of-network chiropractic care, YOU, the patient, will get that bill. As a patient, you are a customer of the insurance company and if you’re not happy you have the choice to get different insurance. If you keep getting bills for chiropractic care that is supposed to be covered as a part of your insurance plan then it’s not likely you’ll continue buying insurance from them. Sadly the Affordable Care Act (Obamacare) is making it more difficult if not impossible to shop for different insurance carriers.
  • If you are receiving treatment from an in-network chiropractor and the insurance refuses to pay for the chiropractic care. EVEN THOUGH YOU STILL HAVE “X” NUMBER OF VISITS ON YOUR PLAN, the insurance company can refuse to pay. So your chiropractor doesn’t get paid and can do next to nothing about it. This happens a LOT. Like every single chiropractor deals with this on almost a daily basis. It’s understandable that this happens a lot now as a result of the over utilization of non-specific chiropractic care in the 80’s. The problem now is that chiropractors who treat using science-based corrective techniques that have been validated by research, insurance companies are still able to determine the patients need and no one is able to keep them in check. It is then very common for insurance companies to employ chiropractors, medical doctors, or even high school graduates to tell your treating chiropractic what they can or can’t do if they want to get paid. Three guess for how much chiropractic care your insurance company wants you to have. You guessed it, very little to next to none.
  • Using only in network insurance is the equivalent of going to MD because insurance pays for 2 days’ worth of a necessary 10-day antibiotic prescription.

• MYTH: IN network insurance chiropractors are better quality chiropractors

  • For reasons discussed in a separate blog (In Network vs. Out of Network Insurance for Chiropractic), Corrective Chiropractic chooses to remain an Out-of-Network Insurance Chiropractic Provider. As a result of this decision, it is very common for us to get calls from potential patients who get rather irritated or confused when we explain to them that we are out of network with their insurance. Some potential patients have even gone so far as to yell, curse at our front desk manager both on the phone and in the office. Many do not understand that our decision to remain out of the network, often, is primarily for the patients’ benefit. This decision does not benefit us, in fact, it’s often quite the opposite because the QUANTITY of patients that we see is much less than would be the case if we were in the networks. This allows for a higher QUALITY of chiropractic care.