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Insurance Details

HOW DOES MY INSURANCE WORK?

IN NETWORK:

This means your physician has contracted with your insurance company and negotiated set fees for services etc.

In Network Contractors
  • Aetna
  • Anthem
  • Blue Cross (all states)
  • Blue Cross Federal
  • Carefirst

OUT OF NETWORK:

We are not contracted with these providers but will submit claims for you.  You will have to meet your “out of network deductible” before your insurer will pay on your claims.  (These insurers typically use a 3rd party to manage your care for Chiropractic – even if it is a PPO plan) Our experience with these third party administrator (TPA) plans is that along with increased administrations costs, these TPA run plans reduce and limit care while at the same time increasing administrative burdens for the patients and doctors. We hope you respect our choice to remain out of network of these restrictive third party administered health plans.)

Out of Network Contractors –
  • Cigna & Cigna Samba
  • GEHA
  • Kaiser
  • UMR
  • United Healthcare and all UHC products

Tricare: Tricare does not cover any services performed by a Chiropractic.  We are happy to say new legislation signed last year should be changing that soon!

Medicare:

We are not participating with Medicare and therefore cannot treat a Medicare patient.  Medicare patients are able to schedule cash services such as Massage Therapy and Yoga and Reiki Therapy and Hypnotherapy at our clinic.

Your deductible is the amount you pay for covered health care services before your insurance plan starts to pay. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.

Your coinsurance is the percentage of costs you pay after you've met your deductible. A 30% coinsurance means your plan pays 70% of allowable fees and you pay 30% after the deductible on your plan is paid/met.

A copay is a set rate you pay for prescriptions, doctor visits, and other types of care. Chiropractic & Physical Therapy are specialties, so your co-pay will be a Specialist Copay.

The allowed amount is the discounted price your insurer negotiated with your provider/doctor in advance for that service. Ex. The doctor charges $40 for a procedure and your insurance plan allows $35. The balance is written off.

Your health plan will typically allow a set number of visits for Chiropractic and Physical Medicine/Physical Therapy per service year or calendar year.  We do our best to help you track your limit, but ultimately this is your responsibility as we cannot track what you have done outside of our office.  Once you have exceeded your benefits, we offer affordable self-pay rates.

If you don’t have insurance or your insurance plan does not cover care at our office, or your plan is out of network with a high deductible which you feel you will not meet, you have the option of using our Self-Pay rates.  These fees are discounted 15% from what will bill insurance. When using Self-Pay rates, you  pay the fees for service at the time of your appointment. We are legally permitted to discount insurance rates because: 1. We don’t have the administration fees of submitting to insurance, possible appeals etc.. 2. The patient pays at the time of service, avoid administrative expenses of billing the patient.

Maintenance care is preventative care recommended to maintain wellness and prevent recurrences of painful and costly episodes. We find people that do this feel better and save time and money in the long run.  When you are feeling your best, you are more productive, can more easily adapt to changes in life and are happier over all.

Maintenance care is typically not covered by insurance as most insurers operate in a “sick” care model and only pay for services when you have a complaint or pain that we can document is improving with care, thus, unfortunately maintaining care is not considered.

YOU ARE AN OUT OF NETWORK PROVIDER FOR MY INSURANCE.  HOW DOES THAT WORK AND WHAT ARE MY OPTIONS:

WE WILL SUBMIT CLAIMS FOR YOU, just as we would if you were in network.

As an OUT OF NETWORK PROVIDER, we will submit claims for all services rendered to your insurer.  You will be responsible to pay the amount applying to your out of network deductible. (This deductible is typically, but not always, higher than your IN-NETWORK DEDUCTIBLE.)  Until you meet your deductible, we will collect $60 at the time of service toward the amount due for the visit.  This is not the entire fee.  As the claims come through, we will bill you monthly for the balance due after the insurance has processed your claim. This amount will be in addition to the $60 collected at the time of service. Once your deductible is met, you will not pay at the time of service and will be billed monthly for your coinsurance.

If you have a high deductible which you feel you will not meet, you have the option of using our Self-Pay rates, which would be 15% lower.  In this case you would pay the fees for service at the time of your appointment and we would not be billing your insurance.  We are legally permitted to discount insurance rates because: 1. We don’t have the administration fees of submitting to insurance. 2. The patient pays at the time of service.

Yes!  Whether we bill your insurance or you use our Self-pay rates you are able to pay using a Health Savings or Medical Savings account for ALL services at the OM Center except for Reiki or Hypnotherapy which are not yet billable to insurance.  You may also use your HSA card for all durable medical equipment (ice packs, foam rolls, cbd products, etc.)

AUTO ACCIDENT, PERSONAL INJURY, AND WORKER’S COMP CARE

AUTO AND PERSONAL INJURY

First, we are sorry you were in an accident.  We will do everything in our power to get you feeling better.

We realize you may have questions about how payment is handled.      Our main concern is to get you feeling better.     Our secondary concern is making sure everything about your case is well documented so your care is paid for and you are able to reach a settlement as easily as possible with all the parties involved.      In order to do this, we have documentation for you to complete.

As far as payment is concerned, in the state of Virginia, you have 3 main options.

First of all- who is at fault?  Did someone hit you?

If someone else was at fault, your best-case scenario, typically is:

Option 1.

We submit to all of the following:

Your Health Insurance – you are responsible for any copays or deductibles at the time of service.

Your Personal Auto policy (you were not at fault so your premium cannot be increased) (when you call they will often advise you to bill the third party, to which you should say I pay for my coverage and I understand it is my right to submit for payment)  We can have them pay you directly, this will cover your deductible and or copay and any remaining money goes in your pocket.

The third-party insurance of the person that hit you. (They will settle with you at the end of care and will pay you directly).  If your health and auto paid your claims at our office ALL this goes in your pocket.

When would someone opt to NOT bill their health insurance?
(If they are out of network with a large deductible.  *UHC, Cigna – Cigna has additional restrictions that may not pay for all their care.  If it is the beginning or near beginning of the year and they use their health insurance for chiro regularly, they may want to save their benefit) 

Workers Compensation

If you are injured on the job, it is important you report your injury to your employer as quickly as possible.  Your employer’s authorized company representative must provide you a list of caregivers within (3) working days.  If no panel is provided, you may choose any doctor you like

The first “treating” doctor for any injury be it the Primary Care, an Orthopedist, or one of our doctors, that first treating doctor becomes the Doctor of Record and will be the Employee’s Doctor of Record who will manage all aspects of the patient’s care, including referrals. Our goal is to get you back to your pre-injury health as quickly as possible, enabling you to get back to work and back to life.