Please note that Adams Chiropractic Offices is not a participating provider with any PPO or HMO insurance networks.
Q - What is Adams Chiropractic's Financial Policy for people with health insurance?
A - We are happy to bill insurance for all of our patients as a courtesy to them. But we do not take responsibility for knowing any patient’s eligibility, coverage or benefits. We are simply forwarding your claim to your insurance company on your behalf. Any amount left unpaid by any patient’s insurance is the sole responsibility of the patient.
In addition, our acceptance of your insurance card is not a statement to you to the effect that:
- we expect your insurance to cover the fees incurred by services you receive, or . . .
- we are willing to discount our fee if the amount covered by your insurance plan is less than you expected.
Q - What if I have an HMO or PPO Plan?
A - If you have coverage with an HMO or PPO, your freedom to see any provider of your choice with the same coverage will be restricted. To get the same benefits, you would have to stay within the network. Adams Chiropractic Offices is not affiliated with any health maintenance organization (HMO) or preferred provider organization (PPO). For all insurance plans, our office would be considered “Out of Network”. However, many PPO insurance plans will cover some “Out of Network” services. If you have a PPO plan and want to know if your plan will cover your treatment here, it would be best to call your insurance company and ask them if you have "Out of Network Chiropractic Benefits". Since we are not a PPO or HMO provider, you may not have coverage if you have a PPO plan, and you definitely will not have coverage if you have an HMO plan. If your plan does not include out-of-network chiropractic benefits, please see our "No Insurance" Frequently Asked Questions.
Q - Why have Adams Chiropractic Offices chosen to not be members of PPO or HMO networks?
A - The reason the doctors of Adams Chiropractic Offices choose to not participate in HMOs and PPOs is because they believe that the most important relationship is the one between the doctor and the patient. They do not want to create a conflict of interest by binding themselves to an insurance company which may obligate the doctor to provide care based on restricted predetermined guidelines of what the insurance company feels is appropriate rather than what the doctor and the patient feel is in the patient's best interests.
Q - What should I know about American Specialty Health Plan insurance?
1 - American Specialty Health (ASH) is an HMO insurance plan. ASH demands a great deal of time-consuming medical documentation in order for ASH to determine that your treatment meets their standard for "medical necessity". The information ASH demands would require the doctor to perform a full examination costing $85 - $165 on each visit. Often after receiving this documentation, they will still deny receiving the documentation or refuse to pay anything; or if they do pay, it is a fraction of the patient's fee. Therefore, it only costs the patient more money.
2 - A number of other insurance companies (Blue Cross, Blue Shield and CIGNA are examples) will contract with ASH to process their chiropractic claims. So your chiropractic coverage could be covered by ASH without even knowing it.
3 - American Specialty Health (ASH) will sometimes ask for records "for review of Emergent/Urgent Services." Essentially what they are asking for is proof that your visit in our office was the equivalent of a visit to an Emergency Room or Urgent Care Clinic. Adams Chiropractic is not an Emergency Room or Urgent Care Clinic, and we cannot prove that services rendered are Emergent/Urgent Services. Therefore, any such requests by ASH will be not be responded to.
4 - Adams Chiropractic Offices has instituted a $15 ASH medical reporting fee. If a patient requests that we send a detailed medical report to ASH in order to support bills, Adams Chiropractic will assess a $15 medical reporting fee for every request we receive for a detailed medical report. Why is this? ASH places very high demands on our doctors to provide excessive and unreasonable amounts of medical paperwork in order for ASH to handle the claim. Adams Chiropractic Offices must assess an additional fee in order to cover the administrative cost of ASH’s documentation demands. No other health insurance company in the industry places such a costly burden on chiropractic providers.
Q - How much will the fees be for the initial visit and future visits?
A - The fees for your initial examination and x-rays may vary according to what the doctor may perform, but usually starts at around $269 - $320. Each adjustment may cost between $59 and $75 depending on how many spinal adjustments are needed (although the cost is usually $59). Your doctor may recommend additional treatment procedures, each of which will have it's own fee.
Q - What is my deductible?
A - Your deductible amount is the amount your insurance expects you to pay before they will begin paying for any treatment for each year. This deductible amount is set by your plan, and every plan is different. For your individual deductible amount, you will need to contact your insurance company. Please note that for many plans, it is not the full amount of the fee which is applied to your deductible -- only your insurance company's allowed amount is applied to your deductible.
Q - What is my co-pay?
A - Because our office has elected not to participate in any insurance networks or PPO or HMO plans, there is no set co-pay amount as designated by any particular plan. In short, the amount you are responsible for paying is any amount left unpaid by your insurance.
Q - What are Non-Covered Services?
A - As the name implies, these are services which is not included in the services your insurance has agreed to pay a portion of. Being non-covered, any deductible or co-pay amount will not apply to the non-covered service(s), and the total cost of these service(s) is the patient's responsibility.
Q - What are some of these non-covered services?
A - Because coverage varies widely from plan to plan and insurance company to insurance company, only your insurance company would be able to give you a list of services which it will not cover. Adams Chiropractic does not routinely get a list of services which are covered or non-covered by a patient's insurance. Our doctors recommend treatment based on a patient's individual need, not his or her insurance coverage.
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 insurance card (if you haven't already provided it). Also, the doctor will indicate special codes telling your insurance company his diagnosis – the reason he's treating you. Once we receive your insurance card and these codes from the doctor, we can start billing. And once your insurance company receives your claim, they usually have a response to us within about three to four weeks.
Q - Will I receive monthly statements?
A - Each month you will receive a statement of all services and payments which took place over the previous 30 days. This statement will show the fees, payments received, and accounting adjustments. If you have any questions on any of your statements, please feel free to call our Billing Department for clarification.
Q - Can I set up a payment plan?
A - In case of financial difficulty, a payment plan may be arranged in which the patient may pay for services over a period of time rather than paying at time of service or by each month's statement. Payment plans are then monitored to ensure that all agreements are being kept.
If your plan does not include out-of-network chiropractic benefits, please see our "No Insurance" Frequently Asked Questions.