By: Alyssa Krizek, Office & Billing Manager
When people hear the words ‘health insurance’ they usually want to run the other way or completely tune out what they’re about to hear. And it’s really not our faults! The American HealthCare System has NOT made insurance easy to understand. In fact, 4% of Americans can correctly define their personal benefits such as their IN and out-of-network deductibles, co-percentages, and maximums. This sobering truth leaves millions upon millions of American’s frustrated with stress about what doctor is in their network, stress about services will be covered and what won’t, and how to get their prescriptions.
We know that insurance can be very confusing but at Wash Park Chiro our goal is to make sure that you know how health insurance works at our office and we will break that down below. We are passionate about helping all people understand the basics of insurance.
First thing’s first: Wash Park Chiro is OUT-OF-NETWORK with all insurance companies. We know that with that one mention of an insurance term and we’ve already lost 50% of our audience...try and stick with us! What does out-of-network mean? Out of network simply means that the doctor or facility providing your care does not have a contract with your health insurance company. Conversely, in-network means that your provider has negotiated a contracted rate with your health insurance company. Ultimately this means the responsibility lies with the patient to know deductibles, what is owed, and what you get out of your own health insurance.
So now you’re thinking...why would you choose to be out-of-network with insurance companies, it doesn’t seem like that is beneficial to people? One of the biggest reasons Wash Park Chiro is out-of-network is that your treatment plan and appointment length is dictated by the doctor rather than the insurance company. As a result, out-of-network providers are able to spend more time with patients and consequently provide more quality and focused care. Because of the quality of care, patients may notice a faster recovery and fewer overall treatments. Out-of-network providers also tend to attain advance certifications. Our chiropractors are certified in Pediatric, Prenatal, and Sports Chiropractic.
Being out-of-network does not mean that we don’t take insurance, we WILL bill insurance, it just works a little differently at our office. With out-of-network insurance, there is usually a separate deductible that must be met and collected before the insurance company will pay for services. After that, your insurance company will cover a percentage of your care and you will be responsible for the rest.
Now we know what you’re thinking…”GREAT! Maybe my deductible is low enough to be met within a few months then my co-insurance will kick in and I will pay a lower rate!” This is where our front desk staff will step in to find out what your out-of-network deductible is (not to be confused with you IN-network deductible, these are two separate deductibles) and see if it would be possible for you to meet your deductible within a reasonable time frame. With this being said, there are a few things to consider:
1. If your out-of-network deductible is more than $900 dollars, we usually suggest that you pay our time of service or cash rates.
2. Think about it...the rate per chiropractic appointment at our office is $75 (this is the required insurance rate), it will take you 12 visits (75 ÷ 900 = 12) to meet that $900 deductible BEFORE your insurance starts paying for anything. For most people on a maintenance plan where they visit us once a month, that would take them the entire year to meet that deductible before it resets again. Take the above example and compare it to our cash rates: they are much lower than the above insurance rate of $75. We offer a time of service package that is 6 visits for $330 ($55 per appointment). If you were to buy two packages per year, that would mean you would spent $660 in comparison to $900. So in this case it would not benefit the patient to go through insurance but to pay the time of service rates. **Note** If you are a potential new patient to us, the price of the new patient appointment can be counted toward your deductible.
3. Maximums: many insurance companies have set maximums for chiropractic visits. It is important to pay attention to these maximums because while most people think they can meet their deductible, they may have a limit of chiropractic visits they can use until their insurance company tells them they have hit their maximum number of visits. So, after paying that higher rate per visit all year long, you have no other choice to go back down to the cash rates you could have been paying all year along.
So where do we go from here? If you’re a prospective patient, give us a call if you have any further questions about health insurance. Upon booking your new patient appointment, you can also tell us your insurance carrier, member ID, date of birth, and first & last name, and our front desk assistant will help you figure out what option will benefit you the most at our practice. If you have any further questions, please email our office manager Alyssa at firstname.lastname@example.org
Alyssa Krizek is the Office Manager at Washington Park Chiropractic and is from Southern California. She graduated from California State University, Los Angeles, and earned a Bachelors in Liberal Studies and a minor in Women’s and Gender Studies. Additionally, she is NASM-GPT certified, TRX STC and GTC Certified, and is Crossfit L1 Certified Trainer.