Understanding Chiropractor Insurance Coverage

Patients often want to know what their chiropractor insurance coverage is. Health insurance can be confusing and can vary between different health insurance providers. Today we will help to explain some of the basics to understand your coverage if you have health insurance.

Illustration of the human spine. About chiropractor insurance coverage.

Terms to Understand:

  • Deductible: The amount of money that you owe before your health insurance starts to pay for healthcare services in a calendar year. For example, you may have a deductible that is $1000.
  • Coinsurance: The percent of the total that you owe after you have met your deductible. For example you may have a 20% coinsurance. In the 20% scenario, your health insurance will pay 80% and you will pay 20%
  • Out of Pocket Max: The total amount that you as the patient will owe for the calendar year. Once the out of pocket max has been met, your health insurance provider will pay 100% of your healthcare costs. The deductible, coinsurance and copays all count towards your out of pocket max. For example your out of pocket max could be $5,000 per year.
  • Copay: Often confused with coinsurance. A copay is a flat amount that you owe for a service and does not count toward your deductible. For example you may have a copay of $40 per visit.

For the above scenario, the patient would be responsible for paying $1000 before their health insurance would start to cover services at 80%. Once the health insurance company starts covering 80% (i.e. once the patient reaches the $1000 threshold), the patient would pay 20% of the health care costs. The patient would also be responsible for any copays even if they have reached their deductible (each insurance plan varies on what services have a copay and what services do not). Anything the patient pays out of pocket (deductible, coinsurance, copay) would apply to the Out of Pocket Max. In this example, once the patient reaches $5000, the health insurance company would be responsible for 100% of the healthcare costs for the remainder of the plan year–including copays.

Other items to know regarding your chiropractor insurance coverage would be if your health plan has a visit limit per year for chiropractic care and if your health insurance plan requires pre-authorization for services. We are happy to explain any of the terms and chiropractor insurance coverage amounts further as needed so that you understand the cost of care–it can be confusing! Most health insurance plans do cover chiropractic care.

We always recommend making an appointment for any new onset spinal and/or extremity pain as well as for re-aggravations of previous symptoms to properly diagnose the underlying cause and to determine the most appropriate treatment.

To make an appointment, click on the following link: https://ledermanchiropractic.janeapp.com/

Yours in health,

Lederman Chiropractic & Sports Medicine

We guide our patients with effective strategies for pain relief so that they can get back to the activities they love.

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