Do You Take My Insurance?
I get asked this question almost every day: “Do you take insurance?”
It’s usually followed immediately by “Why don’t you take insurance?”
The short answer is this -
Insurance paid chiropractic care is diagnosis-driven and restricts the total number of visits and type of care available to patients. This ultimately limits the flexibility of care and outcomes that I can offer to my members and patients.
Many health professionals now choose not to work directly with insurance companies, but as out-of-network providers. This ensures that we, as your doctors can make care decisions that are purely based on professional expertise and not on health insurance policies.
The long answer is this -
I have chosen not to be an in-network provider for insurance companies because:
#1: I specialize in helping people get to the bottom of complex conditions. Currently, insurance companies will only cover chiropractic care for a narrow band of pain-based, muscle, bone, and joint conditions.
This does not begin to include the wide range of benefits that people receive from chiropractic care. It also fails to account for other things that are going on with the whole person that comes in for a visit on any given day.
For example, my patients and members include:
A working mom with recurring aches in her knee, hip, low back, and neck, whose main goal is to be able to keep up with her job, kids, and social life, and still make her 5:00am workout without being slowed down by constant pain. She wants to be able to come in at the first sign of pain and not rely on medications to feel good.
A young professional and weekend warrior whose aiming to get ahead in her new career, train for her next half marathon, and keep her anxiety in check. She wants to come in pro-actively to keep her body moving well, recover from injuries faster, and prevent flair-ups of her Multiple Sclerosis.
A 70 year-old retiree with a long history of debilitating back and foot pain, with a new love for working out. He wants to maintain his pain free condition so he can keep working out six days a week, and still walk his daughter down the aisle next month without limping.
None of these people could get the proactive care they seek within the insurance model. It’s far more effective for me to offer them a proactive care membership, which can be paid for out of their HSA or FSA accounts (more on this later.)
#2: Insurance companies will not cover proactive or preventative care.
Insurance billing requires an active diagnosis code for a current pain condition within the narrow scope that I mentioned above. If someone comes in proactively to prevent pain and injury, the insurance company has no model for paying for that care.
#3: Some insurance companies, including Medicare, will not even pay for an exam performed by a chiropractor. A huge part of providing appropriate care is being able to do a comprehensive intake interview and exam.
At this point I often get the following follow-up questions:
Q: “I have great insurance through my work. We never have to pay anything at the doctor’s office - ever.”
A #1: There’s a big difference between insurance billing for medicine and chiropractic care. Medical Insurance was designed to work with drug and surgery providing doctors. The number of visits required, type of care provided, and diagnoses allowed for treatment all affect the care that will be paid for.
A #2: Also, most modern medical facilities have their doctors operate under strict restrictions that limit visit time, topics that can be discussed, procedures that can be done, and treatments that are given for certain diagnoses. Their critical thinking and clinical reasoning are severely restricted by these guidelines. Not only does that limit their ability to provide care for you, but it’s also a huge contributing factor to the high burnout rates that we’re seeing with medical providers.
Q: But I used my insurance for chiropractic care in the past and it covered everything. Why isn’t that the case here?
A: Insurance can cover some chiropractic care when the chiropractic company is willing to work within the confines set by the insurance company. If you would like help finding one of these providers in the New Brighton area, I’m happy to help you.
All of that being said, there are a few ways that you may still use your insurance benefits to cover your care with me.
#1: The easiest way is to pay with your Health Savings Account (HSA) or Flex Spending Account (FSA). Both of these accounts are pre-tax money meant for covering exactly these kinds of health-related expenses.
#2: If you were involved in an auto accident and are seeking care for the injuries related to that accident, then I can work with your auto insurance company directly to get your care covered. These kinds of accident-related acute injuries are what that insurance is provided for. They fit well within the restrictions set by the liability insurance companies.
Bear in mind that the same rules around diagnoses and proactive care still apply. Once you have recovered from injuries directly related to the accident, they will stop covering your expenses.
#3: The more complicated way would be to use out-of-network benefits.
For most people, the out-of-network benefits only cover a portion or percentage of the fee. They usually have a deductible that you need to meet first before they even go into effect. Oftentimes, that deductible is pretty high.
Here’s how you find out what your insurance company will reimburse for an out-of-network provider:
Call the customer service phone number listed on your insurance card.
Ask, “I want to work with an out-of-network chiropractic doctor, how much will you reimburse me?”
Ask, “What is the best way to submit my claim with a super-bill?”
Make sure that your benefits are clear to you.
Get a fax number or address where you can send your super-bill and insurance information.
Based on the information above, if you do have out-of-network benefits for chiropractic care and would like to use them, here’s what we can do:
You’ll pay the fee at the time of the appointment.
I’ll provide you with a super-bill, complete with all of the necessary codes for your insurance company. Generally, I provide super-bills on a once-a-month basis, if you requested them prior to receiving care.
You will then submit the super-bill, which I will provide you with, to your insurance company.
Make sure to include the following:
The super-bill you received from your doctor
A photocopy of your insurance ID card, front and back
Keep a photocopy of all the documents you send in for your records.
The insurance company with send your reimbursement directly to you.
If your insurance company requires other documentation, please forward that correspondence to Dr. Tom Pastor so he can get you the proper information needed.
FYI - Release Authorization:
Be aware that should you choose to submit a super-bill, you are releasing medical information that is protected by law. This means you are waiving some of your rights to privacy and confidentiality. It is standard for your insurance company to keep a record of your diagnoses stated on the super-bill as part of your permanent medical file.
I hope this helps answer your questions. If there’s anything else you’d like to ask me about, you can reach me at 612-314-3139. I’m happy to answer any questions you may have.