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Billing Updates from Amy

Chest up, strong back.

Billing Updates from Amy

Happy New Year to everyone. I would like to take this moment and discuss insurance policies and how they work in regards to Chiropractic care.  

The Pennsylvania Chiropractic Association (PCA) is working diligently to try to get all of your services covered by your insurance companies. The American Chiropractic Association (ACA) has created bills that are being sent to Congress for approval along these lines as well. Until change happens, I want to explain your plans and your treatment coverage. 

Chiropractic care is covered while your condition is improving. If there is no improvement within the first two weeks of treatment, the insurance company may deny your claims.  The first two-four weeks are considered “Acute Care”.

After improvement is being made, your treatment schedule may reduce to once a week or even once a month. However once you are feeling better, and the condition has improved, then your case moves into a maintenance phase. Maintenance is usually seen as being scheduled multiple weeks out in advance for most people. This is not always covered by your insurance. 

The purpose of this explanation is to make sure you are aware of your insurance policy and understand Acute Care verses Maintenance Care. Some people have policies that state they are allowed a certain number of visits a year. These visits follow medical necessity. Medical necessity means you are currently dealing with a situation which requires care as stated by their insurance rules. Maintenance care unfortunately is not seen as meeting medical necessity standards and may lead to a patient’s visits not being paid for by their insurance company. If your insurance stops paying for your care, patients may continue to be seen by paying the office visit cash fee.

Every patient will have a treatment plan they should follow. Life does get in the way sometimes and appointments get delayed, cancelled, or missed. Sometimes the first visit helps the pain so much that the rest of the treatment plan is voluntary canceled by the patient prematurely. Please understand insurance companies will view large gaps in care as maintenance if a patient chooses to return in greater than two weeks from their previous visit.

I suggest being compliant with your treatment as much as possible. It’s healthier for you, saves money in the long run, and prevents you from being denied by your insurance carrier. So until congress passes new rulings, we will continue to fight for our right to have wellness care visits paid. Chiropractic care has been shown to reduce overall medical expenses by being a more cost-effective and safer method to managing low back pain when compared to the traditional medical route.

If you have any questions regarding your insurance please feel free to call me anytime.

Have a healthy and happy new year!

Amy Carr

Medical Billing Manager at Summit Chiropractic and Wellness

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