How Medicare Works at Wash Park Chiro

By: Alyssa Krizek, Office & Billing Manager


Medicare--If you are here reading this blog you already know the unfortunate truth that Medicare doesn’t cover most unconventional services, chiropractic being one of them. Even though this is our stigmatized reality we face as a Chiropractic office, we know that chiropractic adjustments for the senior population can relieve pain, solve back and neck injuries, increase range of motion, improve posture, and alleviate other problems stemming from general aging. Many studies have shown that if a senior receives regular chiropractic adjustments, their chances of falling decrease.


So what chiropractic services are covered under Medicare and what are not? The most important information that all potential Medicare Patients coming in to seek treatment in our office should know is that Medicare will only cover spine related injuries and manipulations that are needed to correct the spine. So what about other treatments you receive for hip, knee, wrist injuries, or services such as spinal decompression, laser therapy, acupuncture, or massage? Because these injuries and services are not related to the spine, Medicare will deny the claim and reject reimbursement. We can still treat you for these injuries of course, but you will not be reimbursed by Medicare for the service that you paid for.


How Payment Works

So how do you know if you will be reimbursed for you visit? The answer is, if you’re coming in for most back and/or neck pain, the service will most likely be partially reimbursed by Medicare. Patients at our office will always pay at the time of service. For potential new patients to the practice, Medicare does not reimburse for the initial exam, only the spinal manipulation performed that day.  Each patient’s pricing will fluctuate for each visit depending on what service is performed. Our range of pricing for Medicare visits related to the spine is $31.76 - $55.00 per appointment. Patients in our office are typically reimbursed $15-$30 per visit. You should expect Medicare to directly reimburse you up to 90 days after the date of service for again, only spine related office visits. 


Supplemental Insurance

Supplemental insurance is intended for seniors who would like to have benefits that original Medicare does not cover. It is possible that we can try to submit non-spinal injuries or modalities and wellness/chronic care and see if your supplemental will pick up part of the bill. Supplemental insurance usually reimburses our office directly, so when we receive the reimbursement we will put it as a credit on your account that you can use toward your next visit. Note, reimbursement through your supplemental insurance is not guaranteed.


Replacement Medicare Plans

Medicare replacement plans are exactly what they sound like: insurance plans that replace Medicare. Most people’s motivation behind replacing Medicare is that they want better benefits and less hassle. Popular Medicare replacement plans that we see come through our office often such as Humana and United Healthcare PPO plans will potentially cover a range of chiropractic services depending on what your out-of-network deductible is. Please note that we do not accept any HMO plans. If you are unsure of what type of plan you have and this applies to you, simply look on the front of your insurance card to see if says HMO or PPO. Please bring your card in at the time of your first visit and we can check your benefits to see what will make sense payment-wise with your plan.


That is really all there is to it when it comes to Medicare at Wash Park Chiro. We know that Medicare and dealing with insurance can be a pain, but we aim to be as clear and helpful as possible. Please read the FAQ below, or email our office & billing manager Alyssa if you have any more questions frontdesk@washparkchiro.com


FAQ


What services will Medicare reimburse me for at Wash Park Chiro?

Medicare Part B (Medical Insurance) covers manual manipulation of the spine if medically necessary to correct a subluxation.


If my doctor orders me an X-ray or MRI, will it be covered under Medicare?

Medicare doesn't cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture. 


What is the new patient initial consultation cost at Wash Park Chiro? Will I be reimbursed for the entire amount? 

The initial cost for a new patient appointment will be anywhere from $106.76 to $121.01. Medicare does not reimburse for the exam, only spinal manipulations that happen during that first appointment.


I saw that there could be different prices that I will pay; what does this mean? 

The payment is based off of what service the doctor performs that day, Doctors may work on 1-2 areas of the spine ($31.76), 3-4 areas of the spine ($46.01), or if it is a wellness visit (injuries not related to the spine or monthly maintenance care, $55.00). This price scale is based off of Medicare guidelines and rules and will change yearly.


How do payments/reimbursement work at Wash Park Chiro? 

All patients at our office pay at the time of service. You will pay the full amount for the service provided and if it is a service that we can bill Medicare, you will directly receive reimbursement from Medicare at your home address.


What reimbursement amount should I expect if we are billing Medicare?

Our patients typically see $15-$30 reimbursement for their initial new patient visit and follow-up visits.


What should I expect for paperwork when I come in to your office?

In addition to filling out the chiropractic intake paperwork, you will need to sign our medicare office agreement and depending on the service provided, you may have to sign a Medicare ABN (Advanced Beneficiary Notice). 


Do I need to bring my card(s) to my first appointment?

YES! In order to send your claims to Medicare in a timely manner, having your cards at your first visit would be preferable


If I have a supplemental insurance, can you bill other services provided such as non-spinal injuries or modalities and wellness/chronic care?

Although Medicare does not cover certain services, we can still submit the claims and Medicare will forward it to your supplemental insurance to see if they would like to cover any part of the service. Note, this is not a guarantee that you will receive any reimbursement. 


Do you take Kaiser?

No, because Kaiser is an HMO network, you will have to see a doctor within the Kaiser network in order for the service to be covered under your plan.


Do you take any HMO plans?

No. 


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. She has been the office manager at Wash Park Chiro since October of 2018 and is your go-to person for any questions or concerns. frontdesk@washparkchiro.com (303)744-7100

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