Back in the 1980s, insurance coverage for chiropractic care was straightforward. “You either had health insurance or you didn’t. And if you had it, it typically covered chiropractic quite well, some allowing as many as 60 visits per year,” says Barbara Kemenosh, business manager for Mark Kemenosh and Associates Chiropractic in southern New Jersey. “Today, the landscape is radically different. The marketplace is splintered, with many different plans. Each plan has its own rules and it’s virtually impossible to stay ahead of all the nuances of coverage,” she says.
Know your plan!
Knowledge is power. Since one policy can be radically different from the next, knowing the details of your particular plan is the responsible thing to do—for any kind of medical care.
Barbara recommends everyone take the time to understand their policy and benefits. “There are so many, nowadays. Everything goes much more smoothly when the patient understands their policy,” she says.
It seems a tall order, especially when you think of that phonebook of a printed policy you may not have seen in months. Digging it out and deciphering it can seem daunting. And, depending on the provider, the website may not be much better. “It’s easier to just call your insurance company and ask if chiropractic is covered. Even if you find the printed policy, it could very well be outdated,” she explains.
When you make the call. Barbara recommends asking some very specific questions:
- Does my plan cover chiropractic care?
This is a simple go/no-go. But if you get a yes, it’s best to drill it down a bit. - How many visits are covered, per month or per year?
This will vary depending on the plan. Generally you will get a number of visits covered, per year. This is an important number to know as you plan your care with your chiropractor. - Does it cover all forms of chiropractic, or just certain procedures?
Some insurers limit what’s covered. For example, some will reimburse for old-school spinal adjustments but not for any soft-tissue work, like ART—Active Release Technique therapy. - How does the plan handle chiropractic and physical therapy?
This is a curveball the average person may not be aware of. Some plans put PT and chiropractic in the same category. That creates a potential situation where you receive both and the insurance company will only pay for one. Somebody is left holding the proverbial bag and getting paid may require a time-consuming battle. It can also put the patient in a lurch, thinking they have so many chiropractic visits left, while they really have fewer, since the insurance has been counting PT visits against that total. - What’s the copay?
Some insurance companies set very high copays for chiropractic visits and it’s important to have that information when planning your care.
Call if you get stuck
Like many in the medical profession, Dr. Mark’s practice depends on third-party experts to help figure it all out. “Our billing company is very good at sorting out what’s covered. If you hit roadblocks trying to get the information, call and we’ll do our best to help you,” Barbara says.
At enrollment time
If you get insurance through your employer and chiropractic is important to you, ask your benefits manager or HR department which plans are better for chiropractic.
Your health is an investment
If your insurance just doesn’t work for chiropractic, you have other options for covering costs out of pocket. After all, when it comes to your health, feeling better is well worth the investment—even when the insurance company falls short. Call to learn more.