Many health insurance plans, particularly the PPO (Preferred Provider Organization) variety, have some chiropractic coverage. It’s important to remember that it is extremely rare to have 100% coverage, there are restrictions that apply.
Most health insurance plans have a deductible and co-pay. The deductible is the amount that the patient/policy holder has to come up with out of pocket before coverage takes effect. For example, a policy with a $250 annual deductible will cover treatment after the first $250 of charges of a year. So if you doctor’s bill is $251, you will need to pay $250, and the doctor can bill for the $1 (extreme example).
Then there is the coverage itself, which can be between 50% to 90% depending on the plan you signed up for. The patient is usually billed the remainder. Sometimes the plan coverage is 100% with a fixed co-pay, for example $25. So in this case, if your doctor’s bill is $100, you pay $25 and the doctor bills for the $75.
There is also a maximum number of visits or maximum dollar limit each year limitation for chiropractic coverage; for example, maximum of 12 visits per year allowed or $1,500 maximum coverage per year.
If you would like us to check your benefits, you can request it online by clicking here. Sometimes we can make arrangements to simplify your out-of-pocket expenses, based on your insurance plan.
Dan Perez, DC
San Francisco Chiropractic
(415) 627-9077
