We are providers for many insurance companies. You likely are aware that in today’s economy, the patient is paying more and more of the burden of health care. Each and every year, we see higher deductibles and higher copayments. No doubt, you would like to know if you have coverage before embarking into treatment. Below we will try to give you a snapshot, in general terms, of what your financial responsibility might be with each insurance company.
PIP (Personal Injury Protection)
If you are injured in an autombile accident, there is coverage for medical treatment, including chiropractic care, no matter who was at fault for the accident.
The initial PIP benefit is $2,000.00 for related medical expenses. Thereafter, benefits are coordinated with your private health insurance (if available) up to a maximum benefit under PIP of $8,000.00.
Blue Cross has many different contracts depending upon the company for whom you work. Some plans allow 12 visits per calendar year, other plans allow 20 visits per calendar year and other plans are based upon “medical necessity”.
Co-payments seem to vary from $10-$35 per visit. Other plans require you to meet a deductible and then pay a co-insurance. A deductible is the amount you must pay before the insurance plan starts paying. This may vary from $250 up to $1000 or more.
With your member I D. and birthdate, we are able to verify your eligibility and payment specifics on the Blue Cross website. Meg, our insurance specialist, will be happy to do that for you before you come into the office.
MassHealth has a number of plans that they offer. The typical plan is MassHealth Standard and this plan has chiropractic benefits available. The benefit limit is 20 visits per calendar year.
This plan requires that you get a referral from your primary care physician. Most physician’s offices have a staff person that handles the referrals. All referrals for MassHealth are done online and will indicate how many visits the referring physician is recommending that the patient have with the specialist, in our case, a chiropractor. MassHealth will not pay for treatment without the referral.
If your plan is administered by Neighborhood Health Plan or by Network Health Together, no referrals by the PCP are required.
Medicare pays for chiropractic treatment. They DO NOT pay for the initial exam, which is required under Medicare documentation rules. We give our Medicare patients a DISCOUNT on the initial exam and we charge $40 for that service.
Medicare will pay 80% of the ALLOWED manipulation charge and the patient is responsible for the 20% co-insurance. If you have a SUPPLEMENTAL plan, that insurance will often, but not always, pay the 20% balance.
Network Health Together
This is a MassHealth plan that is administered by Network Health Together. The plan pays for 20 visits per calendar year and there is no referral necessary. No co-payments are required under this plan.
Network Health Forward also administers a plan for Commonwealth Care. This plan does not have chiropractic benefits available.
Christian Science Center, Boston
Neighborhood Health Plan
NHP administers some plans for Masshealth. These plans cover 20 visits per calendar year with no co-payment required. Referral by your PCP (Primary Care Physician) is not required.
NHP also has plans through Commonwealth Care and Commonwealth Choice. These plans do not have chiropractic benefits at this time.