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Understanding Insurance and Financial Policies

We are committed to providing you with the best possible care here at Fern Creek Chiropractic Center, PSC.  For that to occur we do need your assistance and your understanding of our payment policy.

WILL YOU FILE MY INSURANCE?

1.     We will file your insurance as a courtesy to you.

2.     We must emphasize that, as chiropractic care providers, our relationship is with you, not your insurance company.  Your insurance is a contract between you, your employer, and the insurance company.  We are not a party to that contract.  While the filing of insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date the services are rendered.

WHAT IF MY INSURANCE CHANGES?

1.     We must have your new information immediately.  Some policies have timely filing limits as small as 7 days.

2.    If you do not have an updated insurance card, you will be required to pay time-of-service.  No back billing can be accomodated.

3. If we do not have your up-to-date insurance and timely filing has passed, you are responsible for the entire balance.

WHO IS RESPONSIBLE FOR KNOWING MY BENEFITS?

1.     You are - We will also verify your benefits and explain them to you.  However, you are ultimately responsible for knowing your coverage.

2.     Not all services are a covered benefit in all contracts.  Some insurance companies arbitrarily select certain services they will not cover.  Certain policies have specific exclusions regarding what is and is not covered and WHO must perform the service.

ARE YOU A PROVIDER FOR MY INSURANCE?

1.     In general, we are providers for MOST Anthem, Humana, and Aetna contracts.

2.     We are NOT providers for United, Bluegrass, TriCare, or Cigna.

3.     It is your responsibility to contact your insurance company to verify that any physician you see in this practice is a participating physician with your insurance company, and with your specific plan. To be certain that we are a provider for your plan, call the number on the back of your insurance card and ask for “Chiropractic Benefits” to verify.

MEDICAL NECESSITY

We are required to justify medical necessity for all treatment that is billed to insurance based on the chiropractic guidelines set forth by the individual insurance companies.

In order for treatment to be billed to insurance as medically necessary, the treatment must meet certain criteria.  You must be under an active treatment plan with quantifiable, attainable goals for a certain number of treatments.  Re-exams must be performed no more than every 30 days to continue care that is filed with insurance to show continual improvement.

NOT CONSIDERED MEDICAL NECESSITY BY INSURANCE

Although recommended for maintaining spinal health, the following are NOT considered medically necessary treatment for billing to insurance:

  • Supportive care which is long-tern treatment for patients who have reached maximum therapeutic benefit but progressively deteriorate when there are periodic trials of treatment withdrawal.

  • Preventative/Maintenance care which is care that is typically long-term, but not necessary to treat a specific medical condition. Rather it is treatment that would prevent symptomatic deterioration or to promote health and prevent future problems.

NON-COVERED SERVICES

In addition, there are some therapies and treatments that the doctors recommend in certain cases that may not be covered by an individual policy and can not be billed.  These vary from policy to policy, but may include any or all of the following:

  • Erchonia Cold Laser

  • Kinesio taping (strapping)

  • Chatanooga decompression therapy

  • Dry Needling

  • Vibration plate therapy

  • Rehab/strengthening therapy

  • Extremity adjustments (that are not directly associated with a diagnosed spinal condition)

WHEN DO I PAY?

1.     Co-payments and co-insurance are due at the time of your visit, and we are not permitted by law to waive these payments.  We must collect all co-payments and deductibles designated by your insurance carrier.  Current fraud and abuse laws governing federal, state, and third-party payer contracts mandate that we cannot grant financial courtesy discounts.

2.     After your insurance pays its portion if any, the entire balance then becomes your responsibility.

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We will gladly discuss your proposed treatment and answer any questions relating to your insurance. If you have any questions about the above information or any uncertainty regarding your insurance coverage, PLEASE don’t hesitate to ask us.  We are here to help you.