Ask the Chiropractor- How does medicare work with chiropractic? Dr Hulsebus attempts to answer this. He was the International Chiropractic Association Chairman on Medicare. His father Dr Michael Hulsebus defended Medicare patients rights on Capital Hill, and his Grand father helped write the legislation for Medicare to cover Chiropractic. #healthy815 #ICAchiropractic
- Hello, I'm Dr. Brant Hulsebus, chiropractor. And I'm coming at you with another edition of Ask the Chiropractor. Ask the Chiropractor is my podcast where people have a question about chiropractic care or how chiropractic works and they don't know who to ask. A lot of times mistakenly they'll ask their family physician about chiropractic care. And I say mistakenly, because your family physician doesn't study chiropractic. He doesn't really know what chiropractors do or don't do. So instead of asking your family physician, ask a chiropractor about chiropractic, the same way you'd ask a dentist if you had dental problems. So I'm a chiropractor, Brant Hulsebus. I'm a third generation Palmer College of Chiropractic graduate. I'm the official team chiropractor of the UHL, excuse me, the AHL IceHogs, the Rockford IceHogs, formerly the UHL and currently the AHL. And I'm here in Rockford, Illinois. We have a practice. I'm the Illinois delegate of the International Chiropractic Association. And I'm the former Medicare Chairman of the International Chiropractic Association. So why did I bring up the International Chiropractic Association and me being the Medicare former Chairman? Why I bring that up because today's episode's about Medicare and chiropractic. How does Medicare work with chiropractic? If I have Medicare, do I have chiropractic coverage? Well, if you have Medicare Part B as in boy, you do have chiropractic coverage. And the way it works is very simple. You have coverage, you come in the office. If you met your deductible, the Medicare will cover 80% of your chiropractic adjustment. Now let's talk about all of this 'cause of course it's Medicare. It's never quite that easy. Let's talk and let's break it down a little bit more. Let me tell you why I'm the expert on this and why you should listen to me. First of all, let me talk to you about my grandfather. My grandfather was one of the many chiropractors that worked around the clock to get Medicare to cover chiropractic. Back in the day, it was his goal to help legitimize our profession. He felt as if federal programs like Medicare would cover chiropractic, it was hard for people to say that we weren't a real thing since the federal government recognized this. The second thing that happened was in the late '90s, early '00s, Medicare my father kinda had a little skirmish about chiropractor's rights and discrimination. And my father went all the way to Washington DC and testified on Capitol Hill. And he's one of the few physicians if not the only physician to ever win his case against Medicare. So we know quite a bit about the Medicare stuff. So you might hear something different from different people. I'm just telling you my background is the fact that my grandfather helped write the laws. My dad helped to find and protect the chiropractors. And that more importantly, the chiropractic patient's rights in order to get chiropractic care. And today I do a lot of research working on, I work with different congressmen trying to improve the Medicare law so that that's where my knowledge base comes from. So yes, chiropractic care is covered by Medicare Part B. You come in and you get your adjustment and they'll cover 80% of the visit. Now, let's talk about what Medicare doesn't do. Well, Medicare requires proof of why you're here. They'll help pay for the correction of vertebral subluxation. That's what chiropractors do their adjustments on. But to help pay for that, the catch is you have to have proof that it's there. Now, traditionally Medicare accepts two types of proof. One would be a complete chiropractic examination and these would have to be done routinely from time to time as your condition changes, you have to do another exam. Come back in three months later, something else was bad. Then we do another exam. That's what Medicare covers. Medicare covers, that's what Medicare wants us to do. They want us to continuously do those exams. The problem is Medicare does not pay for those exams if performed by a chiropractor. So an only way to get a chiropractic exam is to have it done by a chiropractor. But Medicare does not cover the services FDR performed by a chiropractor. I know I didn't write this stuff. I'm just telling you what it is. It's confusing to me too. The other acceptable form they have is a x-rays. If you have x-rays or an MRI, then Medicare will accept that for proof that you have a problem. Now, here's a two speculations on the imaging. One, the imaging must be within 12 months of the data service. So if you come in today, you're good until August 1st of next year, today being August 1st as I'm recording this. So, if you come in, if you come in today, I take films of your spine and you don't return until July 31st, you're covered. But if you come August 1st, next year, you're not covered 'cause that'll be one calendar year since the films were originally taken. So we can definitely use imaging. Now, the other problem with imaging, just like the exams, they don't cover that either so that you can't have 'em covered here but we can use images from other places. If you have images, x-rays are x-rays it doesn't matter who ordered them and who took them. We just need x-rays of the area that we're gonna take care of. So if you went to an orthopedic doctor and say you had x-rays of your spine and then you wanted to go to the chiropractor, you could sign a release form. You could get a copy of those images. And then we could look at those and use those for your care. That's not a problem, not a problem in this office, at least how's that? I don't need to take my own along unless I have some. However, again, it's whenever those images were taken, a year later they're no good. So even if you, let's say you had the x-rays taken June 30th you come here August 1st, your x-rays expire at June 30th, not August 1st. It's the year from the x-rays were taken. Now we've gone through some Medicare audits. And as long as we have one of those two things, your visits are paid for, no problem, real easy to take care of. So when you come in with Medicare, we either have to take an exam every condition or x-rays every year. Now for us, we prefer the x-rays because you could come in four or five times a year and only have the one set of x-rays that cover you for the whole year. Or you continuously do the exams. Now Medicare has their set rates. So the exams are not, you're not gonna save money by having three exams over having the x-rays. Again, I can accept the x-rays from somebody else. I cannot accept somebody else's exam though, because only a chiropractor knows how to do a chiropractic exam. It's just that simple, just like only a chiropractor can answer questions about chiropractic. I've had other family physicians in my area challenge me on these roles. They often say that, oh, that's not true. A chiropractor can order exams. A chiropractor can order this stuff. They should have that all covered. Now, I don't know what makes them an expert on chiropractic, frankly, because they're not chiropractors. They don't work in a chiropractic clinic. They never did coding as a chiropractor. They never done billing as a chiropractor and they've probably never been to a chiropractic seminar. However, they're usually pretty sure I'm wrong which I don't really understand. So that's kind of how it works. If you have x-rays or exam, you're covered. And so after that, we can see, how many times can you come in? Well, according to the letter of the law, as many times as you need it. Medicare says you come in as much as you want. Now, if you come in a lot, a lot, a lot, are we gonna have to probably go in front of a judge and argue why you had your visits done? Probably, but here that's our job. That's our responsibility to measure that and watch that for you, not yours. So, if you have Medicare, you wanna come in to be a patient, we can definitely help you out. Just be prepared. If you don't have images or you or we have done exam on you, you'll need those taken care of. So that's kind how Medicare works for chiropractic. Now the other weird thing about Medicare is that we cannot refer you out. So if I thought you need to go see a shoulder specialist or if you need to go see a, even a cardiologist, I can't refer you out. If I refer you out, Medicare denies the visit and makes you pay out of pocket. So when you come to see a chiropractor, make sure you tell us the name of your family doctor 'cause a lot of times if we feel that you need to be referred out, we'll call that family physician and we'll tell them what we found and then they can refer you out to make sure Medicare cooperates nicely. So, and again, I don't try to argue how Medicare works in the medical field no more than I think a medical doctor should tell you how, he works in a chiropractic field, fair enough, but if it's fair for one it's fair for all. So I hope it answers your questions about chiropractic coverage with Medicare. And you know what? That's the laws right now, right? 'Cause laws change and rearrange that for people in office, other people lose office and things get changed and rearranged. I can just tell you how it is right now at this moment. So yes, Medicare does a good job of covering chiropractic care. The negative is we have to have proof that you need to be here. And typically the forms of proof are not covered by Medicare. I know it doesn't make sense. I'm working on a new bill to try to change this. I've been working with this for about five years. Hopefully with the next Congress, we can get more done. Of course I've said that in the about four or five times, but hopefully. All right, well I hope I answered your questions about chiropractic care for in Medicare. If you ever have a question about chiropractic care, feel free to leave a comment below, go to RockfordDC.com R-O-C-K-F-O-R-D-D-C.com. Send us a message there. And if you have a question about how your insurance works or how Medicare works, you can give us a call. We'll ask you to get some preliminary information from you so that we can then get ahold of your insurance company or Medicare. In order to get past them. And again, this is for traditional Medicare. Medicare replacement plans, that's a different video, different day. I'm just gonna give you the best I can with generic Medicare. All right, everybody. I hope I answered your question. Dr. Brant Hulsebus, stay healthy, stay strong. See you next time around.