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Is Chiropractic Covered By Insurance?

Posted October 17, 2012 in Advice Column, Ankeny

Medicare covers chiropractic under Part B. If a patient has Medicare and no secondary/supplemental insurance, the patient is initially responsible for paying the annual Part B deductible of $140 for 2012. (This deductible applies to the combined charges for all Part B medical providers, not solely through chiropractic visits.) After the deductible is met, Medicare pays 80 percent. The patient pays the remaining 20 percent, typically around $7 per treatment.

If a patient has Medicare plus a secondary/supplemental insurance, the secondary/supplemental insurance usually pays the initial $140 deductible. Once the deductible is met, Medicare again pays 80 percent, and the secondary/supplemental insurance pays the remaining 20 percent.

It is very important to note: Medicare only pays for the actual spinal adjustment. Medicare does not pay for examinations, acupuncture, ultrasound, massage, X-rays, nor other common chiropractic services. Medicare does not have a visit limit but does require that treatments be deemed medically necessary. Medicare does not pay for routine maintenance treatments.

• Iowa Medicaid/Title 19 covers chiropractic adjustments and X-rays. Depending upon age and pregnancy status, patients have either a $1 co-pay or no co-pay per treatment. The number of treatments allowed is determined by the diagnosis or condition being treated, with a maximum of 28 treatments per rolling 12-month cycle.

• Commercial insurance policies usually cover chiropractic services. Some require patients to pay a co-pay ranging from $10 to $50 per visit. Others require patients to pay a co-insurance or percentage of the total cost ranging from 10 to 50 percent. Some have a combination of the two. On occasion, a commercial insurance requires a patient to pay a deductible prior to paying its portion. Some commercial policies require pre-authorization or utilize third party reviewers to determine patient-care limits.

• Automobile insurance usually covers chiropractic services under the MedPay portion of your policy. Healthcare-related bills are sent to your own auto insurance company despite which driver was at fault. Your auto insurance company will be reimbursed from the other party’s auto insurance company if the accident was not your fault. MedPay is also designed to ensure your healthcare-related treatments are covered, even if the other driver does not have insurance.

• Veteran’s Administration (V.A.) covers chiropractic services. The V.A. only pays for spinal adjustments. Because the central Iowa V.A. does not have a chiropractor on staff, the patient has to ask the V.A. for a referral to our office.

• Iowa Worker’s Compensation, unfortunately for the many patients who could be helped with chiropractic services, does not cover them at this time. On occasion, a patient can receive covered chiropractic care if the Worker’s Compensation Case Manager approves it.

• No insurance. Most chiropractic care is very affordable and, in some cases, less costly than the co-pays required by some insurance companies.

Information provided by Christopher M. Renze, D.C., D.I.B.C.N., of Renze Chiropractic Clinic, P.C. For more information, visit www.renzechiro.com or call the office at 965-3844.





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