Q - What is a Medicare Advantage Plan (Medicare Part C)? What if I have one?
A - If you have traditional Medicare (if your card says “Medicare Health Insurance” with the federal seal on it), skip over this section. It doesn't apply to you.
However, you may be someone who has obtained Medicare benefits from other insurance companies (Kaiser, Secure Horizons, etc.) who offer Medicare-type benefits. Please understand that if you obtain Medicare benefits through an HMO or PPO, you will not have the freedom to see any Medicare provider as you would if you had benefits through regular Medicare. You would have to be within the network, and since we are not a HMO or PPO provider, you probably will not have coverage for your services at Adams Chiropractic.
For the most part, the rest of the information below applies to traditional Medicare.
Q - What chiropractic services does Medicare cover?
A - Medicare does offer coverage for some of chiropractic services; other services are not covered. For complete information regarding a specific service, please call Medicare at the phone number listed in your Medicare correspondence. For a general reference, please utilize the list below:
Examinations, x-rays, other tests, etc. . . . . . . . . . . . . Not Covered
Exercises, therapies, doctor counseling time, etc . . . . . Not Covered
Orthopedic supplies, dietary supplements, etc. . . . . . . .Not Covered
Medicare DOES cover your chiropractic adjustments. In addition, in our office, each visit to the doctor has two procedures included in it; one of the procedures is covered by Medicare, the other is not. These two procedures are:
Spinal adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . .Covered
Extremity adjustment (shoulder, rib, hip, etc.) . . . . . . . . Not Covered
Q - For the spinal adjustment (the covered service) how much will Medicare's reimbursement be and how much will my out of pocket be?
A - Spinal adjustment: 2015 Fee $45.83 Medicare pays about $30.00*
2016 Fee $45.01 Medicare pays about $29.00*
Extremity adjustment: 2015 Fee $ 5.17 Medicare pays $ 0.00
2016 Fee $ 5.99 Medicare pays $ 0.00
*Note: Medicare can change coverage and reimbursement amounts at any time
Q - How many adjustments per year will Medicare pay for?
A - Medicare does not give a specific number of adjustments per year they will pay for, but some of our patients have told us that Medicare told them that they can expect to have about 20 visits per year to be covered.
Q - What is a Non-Assigned Office and why will Medicare not pay the doctor directly?
A - Because Medicare has designated our office as a non-assigned office, Medicare will not send their reimbursement check directly to us. Medicare will send the reimbursement check to you and expect you to pay our office directly. Also, because our office is a non-assigned office, we do not write off part of our fees. The amount you are responsible for paying is any amount left unpaid by Medicare.
Q - What is the Medicare Deductible amount?
A - 2015 Deductible $147
2016 Deductible $166
This is the amount Medicare expects you to pay before they will begin making payments. Your deductible begins again every January. Please note that it is not the full amount of the fee which is applied to your deductible -- only Medicare's allowed amount is applied to your deductible.
Q - What are Adams Chiropractic's billing Procedures?
A - The insurance Billing Department sends out insurance claims frequently. To send in your claims, we will need a copy of your Medicare card. We will also need special codes telling Medicare your doctor's diagnosis – the reason he's treating you. Once the Billing Department receives these from the doctor, they can start billing. And once Medicare receives your claim, they usually have a response to you within about three to four weeks.
Q - At the office, I was asked to sign this Advanced Beneficiary Notice (ABN) form. What is it?
A - On each visit, you will be asked to sign an Advanced Beneficiary Notice, or ABN. This is a form Medicare requires us to present you with in order to inform you of services which Medicare will not or may not pay for. If the ABN form talks about services Medicare does not cover, then you should never expect Medicare to reimburse you for them. If the ABN form talks about services that normally are covered (the chiropractic adjustment), then we are merely informing you that there is a possibility that Medicare may not pay. This doesn't mean Medicare won't pay – most likely, it will. But Medicare requires that we inform you of the cost so that you can elect to not receive the service if you don't want it.
Q - I have health insurance that is secondary to Medicare. How does that work?
A - You may have a plan that is secondary to Medicare that will pay a portion of the services in addition to what Medicare pays. Many of these health insurance plans secondary to Medicare allow for what is called a crossover. This is a nice feature: after Medicare processes your claim, they automatically forward the information to your secondary plan, so we don't have take that step ourselves. For other plans, we will forward the claim to your secondary insurance once Medicare sends us their response.
Q - What can I expect the coverage of my Medicare secondary plan to be?
A - This depends on your type of secondary coverage.
1) If you have a Medicare supplemental plan, this plan will only cover any difference remaining on any service Medicare covers. But if Medicare does not cover it, neither does your supplemental plan.
2) On the other hand, if you have health insurance from prior to Medicare that is now secondary to Medicare (in other words, a plan completely separate from Medicare) then your coverage will vary widely depending on your insurance company and your individual plan. But your secondary coverage may very well cover and pay for items which Medicare denies.