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.

Insurance & Financial Policies

Health insurance has changed, especially in the last few years. What you previously found to be covered may no longer be covered unless you meet strict medical necessity guidelines decided by each insurance company. Your care must meet these guidelines to be considered medically necessary. These guidelines include an active treatment plan with quantifiable, attainable goals. Re-exams or outcome assessments must be performed at regular intervals to show continual improvement if the care is to be filed to insurance. See the "non-covered services" tab for more detailed information.

Car Insurance coverage

Kentucky is a "no-fault" state. This means that if you are in an accident (your fault or theirs), YOUR insurance will cover your medical costs up to $10,000 (unless you have more). This is referred to as PIP coverage.

How?
You need to call your car insurance company and file a PIP claim. Provide us with the Insurance company, claims address, and name of your claims adjuster. In short, your car insurance will pay for your chiropractic care under PIP.

Important!!!

If your PIP benefits are exhausted, your health insurance can be billed for only those services that YOUR health insurance covers. You are responsible for co-pays, co-deductibles, and all non-covered services at full charge.

If we are not participating providers for your health insurance and your PIP benefit is exhausted, you are responsible for all charges.

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 therapy
Kinesio taping (strapping)
Decompression therapy
Dry Needling
Massage therapy
Vibration plate therapy
Rehab/strengthening therapy

Chiropractic adjustments that are not covered:

Extremity adjustments (that are not directly associated with a diagnosed spinal condition) or not covered by your policy.
Supportive care: when the maximum therapeutic benefit of an active care plan is reached but periodic care is needed to prevent symptoms from returning or prevent future problems.
Preventative/Maintenance care: long-term care to prevent symptoms, promote health, and prevent future problems.

Insurance

Commonly, chiropractic benefits are included in your health insurance. Depending on your plan, you will pay a copay or coinsurance (a percent) for covered services and your deductible may apply. The best way to know is to call the customer service number on the back of your card and ask these questions:

What are my chiropractic benefits?
How many visits per year? (Does my "year" start on January 1st?)
Do I have a copay or coinsurance?
Does my deductible apply? If so, how much of my deductible remains to be met?

WILL YOU FILE MY INSURANCE?

Yes. We will file your insurance as a courtesy to you.
Please understand that our relationship is with you, not your insurance company. We are not a party to the contract between you and your insurance company. As such, all charges are ultimately your responsibility from the date the services are rendered.

ARE YOU A PROVIDER FOR MY INSURANCE?

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

2. We are NOT providers for United, Bluegrass, TriCare, Cigna, CareSource, Humana, Medicaid, or other plans.

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.

WHO IS RESPONSIBLE FOR KNOWING MY BENEFITS?

We will also verify your benefits and explain them to you. However, you are ultimately responsible for knowing your coverage.
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. (also, see non-covered services tab)

WHAT IF MY INSURANCE CHANGES?

We must have your new information immediately. Some policies have timely filing limits as small as 7 days.
If you do not have an updated insurance card, you will be required to pay time-of-service. No back billing can be accommodated.
If we do not have your up-to-date insurance and timely filing has passed, you are responsible for the entire balance.

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.

Medical necessity criteria varies by company but here are some general rules:

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 treatments for billing to insurance:

Supportive care: long-term treatment for patients who have reached maximum therapeutic benefit but progressively deteriorate when there are periodic trials of treatment withdrawal.
Preventative/Maintenance care: care that is typically long-term, but not necessary to treat a specific medical condition. Rather it is a treatment that would prevent symptomatic deterioration or promote health and prevent future problems.

When Do I Pay?

1. At the time of your visit.

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.

3. If you know how much you owe and would like to pay your statement online, please log in to your Patient Portal account to submit payment.

If you do not have a Portal account yet, please contact our office to receive your sign up link.

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.

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