Insurance – Where to start?

Honestly, there are just way too many questions about insurance that could ever be covered in one blog. Every insurance company, plan, and employee benefits package is different, but we can try to cover a few basics here without hopefully overloading your brains with too many crazy insurance in’s and out’s. So here are some things that may be helpful for you to understand your Chiropractic and Massage benefits, and maybe other benefits.

Insurance Part I

Does your health plan cover Chiropractic and Massage?

Typically most plans cover Chiropractic in some capacity. That may be with a copay for each visit, or basically a “bucket” of money that will cover X amount of things (for example chiropractic, acupuncture, a naturopath etc) and you can choose which benefits you want to use that money for, they may give you a certain number of visits each year at a certain coverage or copay. There are so many variables, it is best to call your member services and ask them for your exact coverage so you aren’t surprised if you use it up and suddenly get a bill. Most medical office to try to keep track of that for you, but sometimes we can’t keep up, so it is highly recommended to try and have a good idea of what and how much of a service is covered to avoid surprises. Massage is a wonderful benefit that sadly a lot of plans do not cover, but it is always good to check! You never know what lovely surprises your health plan may have.

What is a copay/coinsurance?

A copay is an agreed upon amount between your insurance company and your employer/benefit provider of as to what you should expect to pay upfront for different services. Your copay may vary between offices and services. Some services may not have a copay, but may instead have a coinsurance. Your coinsurance is a percentage of the contracted rate that is agreed upon between your insurance and the provider’s office. Your portion of the coinsurance is billed to you after your claim processes. Some providers’ office’s require your copayment at the time of service and may issue a late fee if not paid upfront.

What is my deductible?

Your deductible is the amount you pay for covered health care services before your insurance plan starts to pay. Once you’ve met your deductible, you usually only have to pay your copay and/or coinsurance. No all covered services require that a deductible be met. Some insurance plans have a high deductible.

Your Plan!

  • Check your insurance card for a member services number – usually found on the back (p.s. it is always good to bring your insurance card or new card to any appointment, or just carry it on you in case of an emergency)
  • Call your insurance member services and have your card ready to give them your ID or Group number
  • Ask for member benefits and speak to a representative, they will have all kinds of information on whatever services you are interested in
  • Write it down! Even if you have to call them back in a few weeks or months about another service, it will help you remember the numbers they gave you
  • Some health plans have online sites in which you can make an account for. It will give you more information or keep you updated on your deductible and such
  • And lastly, check with the office providing the service to determine if they accept your insurance. Not all offices are contracted with all insurance companies. So if you use one that is in-network, your coverage will be better!