Health Insurance Education
At Mobility Plus, we believe that knowledge is power! This is especially true for health insurance. The ins and outs of health insurance are not something you want to learn the hard way (i.e. after you get a nasty bill from a health care provider). By taking it upon yourself to learn about health care, you will be able to play a much greater role in your own healthcare and the finances that go along with it.
Can you tell me what will be covered by my insurance company?
Prior to, or during, your initial examination, we will do a brief verification of your benefits. After the exam, we will briefly go over your estimated coverage and cost. We provide this courtesy, because we want to ensure that you have a clear understanding of every aspect of your treatment. This creates the opportunity to work with us towards being the best you, rather than feeling as though your health is out of your hands.
How much does insurance cover?
Our office is in-network and preferred providers with most insurance plans. However, all insurance policies and coverage vary. The best way to find out your coverage is to call your insurance company with any questions prior to your visit. Keep in mind that the comprehensive treatment we provide results in fewer visits required (in lieu of prolonged care) which means to less out-of-pocket expense and more accessible care.
Although we try very hard to give you accurate financial information for your treatment, please understand that what we have estimated as a financial commitment for your well-being is just that: an estimate. The benefit information we give you is based on the information given to us by your insurance company. We strongly encourage you to call the number on the back of your insurance card to confirm the benefit information we have been given. We cannot hold insurance companies accountable for misquoting us, but if you call and receive incorrect information, you can! Make sure that every time you contact a representative from your insurance company, you write down the date and time of the call as well as a call reference number. This will ensure that, should they misquote you, you are able to hold them accountable.
What if I have no insurance or my insurance doesn’t cover your services?
It is best to call our office and speak directly with our patient support staff about time of service rates. We are interested to know what type of services you are looking for to see if we can still meet, or even exceed, your needs.
Do you bill under Chiropractic or Physical Therapy?
Because of the overlap between Chiropractic and Physical Therapy procedures, there is also an overlap of codes we are required to bill insurance companies. These codes are not unique to a certain specialty, such as a Chiropractor vs. a Physical Therapist vs. a Massage Therapist). These codes are required by insurance to be utilized, and simply describe the type of care being provided to the patient. Individual insurance companies can vary in how they allocate payment for these codes. Allocation of codes to Chiropractic benefits and/or Physical Therapy benefits are independent of “how” they are billed. Insurance companies decide based upon their own internal parameters of where to allocate these procedures and do not freely share this information with provider facilities. Therefore, it is necessary to contact your insurance company with any specific questions.
Be your own health advocate by understanding the language used by insurance companies:
IN-NETWORK AND OUT-OF-NETWORK
Providers such as doctors, chiropractors, and dentists can become accredited through an insurance company. This gives providers an in-network status. What this means is that the provider agrees to see you under the terms and fees listed by your insurance rather than by their own terms.
When a provider is not a member of the credentialed group through an insurance company, or they are out of the covered service area, they are considered out-of-network. Your insurance company may still accept claims from these out-of-network providers. However, it is often the case that the insurance company will charge you more out-of-pocket to see these providers.
This is a way to incentivize using some providers and not others, as often times it is more cost-effective to go to a provider that is in-network with your plan. The insurance companies see it this way: if a provider is in-network then they will keep to the plan and benefit guidelines set by the company more closely than those who are not. Additionally, this is a way for your insurance company to make sure that the provider you see is of the best caliber and qualifications in their respective field.
Your deductible is the fixed, specified amount that you (the insured) must pay before the insurance company starts to pay all or part of your claims. Deductibles often renew every year. For instance, if your deductible is $700, that is the amount of medical expenses you will pay for out-of-pocket before your insurance kicks in and begins to pick up the majority of the cost of your insurance claims.
This is a form of cost-sharing between you and the insurance company. Once the deductible has been fully met, the insurance company will start paying a fixed percentage of each claim. Typically, the insurance company has set amounts for each kind of claim that they pay out (see allowed amount). The percentages may vary depending on the service involved. For example, your insurance company may pay 70% of each claim, leaving you with 30% coinsurance to cover.
A copayment, also known as a copay, is a fixed dollar amount, for instance $25, you must pay at the time you receive the medical service. After this has been paid, the insurance company covers the rest of the claim. The copay amount may vary depending on the type of service, and some insurance companies require you to pay your deductible first. At times, insurance companies also require that you pay a copay and carry a small coinsurance. This is especially the case when you see a provider that may not be part of your approved network.
Often times, your plan will dictate how many times within the plan or calendar year you can see each type of provider or service. Typically, the limit is a visit count, for example 20 visits per year. Sometimes visit limits for a service are a monetary limit. For instance, it may be in your plan that you can only receive up to $1000 worth of a service per plan or calendar year.
Please find a link to a PDF of our Notice of Privacy Practices here.