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Insurance terms

I continue to post this blog around the time of open enrollment because it is so important to know what you are buying as far as health insurance is concerned. 

Health insurance can be a challenging concept to understand. At first, it may seem so simple. Yes, you have chiropractic care. But wait… what does a deductible mean and do I have to pay it before I get care? That is just one common question that arises when dealing with health insurance. Here is a brief list and description of terms you may find when navigating your health insurance policy.

  1. Yearly deductible: This is the amount you owe out of pocket before your health insurance kicks in. There are individual and family deductibles, depending on who is on your plan. Some services are not subject to deductible meaning you do not have to meet that deductible before services are covered. This deductible is for all medical care, not just chiropractic so if you have seen different providers or had previous care, you may have met or at least paid money towards your deductible.
  2. Co-pay: This is a set amount you have to pay at the time of service. The amount may vary based on the service being provided. For example, a co-pay for a chiropractic adjustment may be $15, but may be $30 for a massage.
  3. Co-insurance: The amount you owe for a covered service when your plan requires you to pay a certain %. For example, if you have an 80/20 plan, the insurance will pay 80% of covered services and you are responsible for 20%. This goes into effect after your deductible has been met.
  4. Allowable: This is the amount the insurance is contracted with the provider to pay for a certain service.

*Where this can all get confusing is putting the care together. Let’s say you have 12 visits per year for spinal manipulations. However, you also have a $1,000 individual deductible and a $2,000 family deductible. If your kids/spouse are on your plan, you have to meet the family deductible. Furthermore, you may have a 20% coinsurance. So, let’s say you come in for an adjustment. If the insurance allowable is $40 but in your plan, spinal manipulation is subject to deductible, you have to pay that $40 out of your own pocket. If spinal manipulation is not subject to deductible but you have a coinsurance of 20%, you have to pay 20% of $40 which is $8. That is just for the spinal adjustment though. When you add in other services such as rehabilitative exercises, extremity adjustments, traction, etc., it gets even more confusing. The biggest problem is we as a medical office do not know your out of pocket expenses because we do not always know what your insurance will or will not cover.

      So what is the take home point from this? Do your research as much as you can. Contact your insurance company and find out as much as you can. Also, communicate with us. We want to help you care the care you need with no surprises.