Insurance, Medicare, and Chiropractic

Ask the Chiropractor-
How does my Insurance or Medicare work with Chiropractic?  Dr Hulsebus explains why you should call your chiropractor and ask about your coverage.  Sometimes it is better if your chiropractor is not in network.  Also Medicare has certain requirements.  #healthy815 #icachiropractor #palmerproud 

www.rockforddc.com

Transcript

Copy Transcript Copied

0:00

- Hello, Dr. Brant Hulsebus here. And welcome to another edition of Ask the Chiropractor. Ask the Chiropractor is my little podcast that I do when someone has a question about chiropractic or chiropractic care I try to answer. I'm a chiropractor here in Rockford, Illinois. I'm a proud graduate of Palmer College of Chiropractic. And I'm happy to be the team chiropractor of the Rockford IceHogs. Let's dive into it. Hello, I'm Dr. Brant Hulsebus. Welcome to the next episode of Ask the Chiropractor. So today, I wanna talk a little bit about a question we get asked a lot, especially out in the public when somebody sees me. The first question I usually always get asked is,"I would like to go to a chiropractor."Will my insurance cover it, will Medicare cover it?" This is a question I'm asked a lot. Now, I'll just talk to you about Illinois. That's what I know when I'm talking to you about how we do things here. Now, some states you might find it's different. Most states, chiropractic is regulated by the state, not by a federal program. Just like, same with medicine, same with dentistry. You have your state boards and your state licensure. We don't have national licensure. So state by state is gonna vary. So I'll do the best answer I can here for Illinois. In Illinois, there's various insurance programs. I'll talk about insurance first. Various insurance programs. And the insurances will usually cover chiropractic if it's part of your plan. Now, every plan is gonna be different, every employer is gonna have different options and choices as far as their coverage. So what you wanna do is you wanna call the chiropractor and give the chiropractor your information. Now, there's many plans out there, given the chiropractic, that are kinda trick plans. So I'm gonna talk about some of these trick plans real quick. Recently, there was a big car manufacturer here in town. And we were in the insurance network, but they didn't cover chiropractic services. So I think they passed through their employees perhaps that,"Yeah, your chiropractors are in our network,"but nothing we do here is covered." So, I don't know, maybe it was deceptive. I don't know what it was, but that's how that happened. Somebody might tell you,"Yeah, we're in the network;"however, nothing that we do is covered." I'm not sure the point of that, but that's the way it is. There's been other plans too where you have to get your visits pre-certified before you can come in. The people who pre-certify your visits don't get hired because they want you to have tons of access. They get hired because they're trying to limit the amount of times as you can come. I believe that, I'm reading some papers are out there, I'm seeing some stuff on the internet. I'm not gonna say this is factual. I'm gonna tell you this is conspectual, that they get reimbursed, they get hired to do that job by denying, but it's not by approving visits. So a lot of chiropractors don't really get involved in those programs because we feel like it's a lot of work, it's a lot of efforts just to get a bunch of denials. And typically, those are the ones also have huge copays. Sometimes they can, some here in Rockford area, more than our cash rate, more than we just normally charge. So why get involved in something we have to solve this paperwork for, get you pre-certified, get authorized, fight for every single visit just to find out that it's an $85 copay? And our adjustments don't cost that much typically. So why bother doing all of it? So sometimes you might find out that,"Yes,"the chiropractor's not in my insurance plan,"not in my network." And that's because it's more advantageous to you. Heck, we've even had some where the out-of-network benefits are cheaper than the in-network benefits. So if I'm in your insurance plan, your copay was $40, but if I'm not in it, it's 25. I have no idea. I always tease here, if you wanna make sense out of these insurance plans, sometimes the best thing you have to do is omit all logic. If you remove the logic from what you're thinking, it all makes much more sense. So call your chiropractor. Don't just go by the card. Call the chiropractic clinic and say,"This is the insurance plan I have, this is where I work."What can you tell me?" A lot of times, the chiropractor can tell you. So the insurance will usually cover your initial care plan when you first come in. So I come in, I'm usually, I mean, most of you come in here because you have a back pain, or neck pain, or headache. And the you'll come in, you'll tell us those things, and the chiropractor is able then to do an examination to verify that there are chiropractic findings that match your complaints. Then we submit all that in paperwork and documentation. And we know each insurance company requires for documentation. Then we'll get all that organized and ready. Then we'll come up with a care plan for you. We'll submit it to the insurance. And then therefore, your insurance should kick in and do their part. Now, a lot of times after people come in for that initial thing that the insurance pays for, they wanna continue to in. Well, insurance does not, typically, there's all kinds of insurance plans. But typical insurance would say,"You can't just go in there because you're feeling good"and you like the way the adjustment feels." You have to have a "reason" to go in. You have to have an anger complaint. And so if you come in and tell me,"Hey, last time I saw you, I was raking the yard."I felt some tightness in my lower back"and I'd just been feeling rundown."I haven't been feeling that good."I believe an adjustment can help me." I will do my chiropractic examination. I will look at my documentation. If it matches up, then we can bill the insurance company. If you come in and say,"Man, I just feel perfect today,"I just know if I keep getting adjusted, I'll stay perfect," those are harder ones to bill the insurance because the insurance doesn't, their policy is they don't cover that type of care. And that's the plan that not I wrote, but that's the plan that the insurance company wrote that you the patient agreed to when you signed up for that insurance. So that's what the plan is. Now, some plans do have wellness care in it. So some places actually say,"Yeah, we find out that if you go with a chiropractor"and get adjusted regularly,"you're not gonna have as many back problems."So we wanna incorporate that as part of our plan." And when those happen, those are easy ones to take care of and take care of you. We just gotta show our positive findings to warrant you being there. You don't necessarily have to have a complaint, we just have to find our positive findings on you. And those are the ones that majority of chiropractors love to deal with because we're able to do real chiropractic where we just find the problems, and adjust you, and hopefully find it before you have it. Not that we don't love to take care of people with aches, and pains, and complaints, but the real chiropractors love to take care of people that keep them well, not try to get them well."It's much easier to stay well than it is to get well" is what we always say. So those are the way those plans work. The chiropractor will probably do an examination. Whether that concludes X-rays or not, it'll be up to the chiropractor. And that's all to validate you have problems. It does two things. One, it shows the insurance company, Yes, there are positive findings. There is a reason to take care of this person. And second, yeah, we need those things to take good care of you. A lot of times, I always find that people that challenge me the most by getting exams, and the X-rays are the ones that challenge,"How many more times do I have to come in?""Why aren't I getting better yet?""What's going on with the care?" And I'm like,"You handcuffed me from the beginning."You wouldn't let me do any of those things."I can't answer those questions anymore."Matter of fact,"I don't even see patients"that don't allow me to do that anymore." It's not, if you're not gonna let me do my job, you're not gonna let me do my standard care, then there's other carpenters that'll see and take care of you. But in this office, we don't do that anymore. Yeah, so that's kind of how the insurance work. Now, Medicare is a little different. So Medicare covers chiropractic. We're allowed to look for vertebral subluxations and do chiropractic adjustments. That's what they cover, and they do a pretty good job of it. Actually, it's not that bad of a program, as long as you can document that you found a vertebral subluxation, you adjusted it. But you have to show that there was interference with your activities of daily living. What does that mean? Activities of daily living means,"When I made the bed, I felt the pinch.""When I got up this morning and did my hair,"I felt something in my neck.""I had a headache"when I was trying to go to bed last night." If you have something, Medicare says you have to have one of those things. So Medicare has these, well, healthcare has these standardized questionnaires, and Medicare accepts these. So when you come into my office, you fill out one of those to show that how it affects your activities of daily living. And as long as you have a positive score on there, we're allowed to take care of you that day. Now, if you come in and you only have one little reading, we could take care of you that day, but we can't see you three times a week for six weeks. That's ludicrous. We'd have to have a bigger complaint, bigger issue to see you. Now, here's the catch in the Medicare. Medicare does require more evidence than just that questionnaire and my exam findings that day, my my shortly, longly chiropractic exam findings. Medicare requires either a full exam, including orthopedic tests and/or images, MRI X-rays, something. It's some type of images. Those are the two forms of proof that Medicare accepts that you have a necessity to be there. However, Medicare does not cover the expense of the exam or the films if they're done at a chiropractic clinic by a chiropractor. But we can't use an exam finding from a medical doctor or a orthopedic doctor. We have to use a exam finding of our own because frankly, they don't know how to do chiropractic exams. So it's kind of a touchy situation because if you get your X-rays taken in our office, you have to pay out-of-pocket for them. If you get your X-rays taken that your medical physician, as long as the medical physician knows what he's doing, Medicare will pay for it. A lot of people wanna argue with me on this subject. Even medical doctors come in and try to tell me that's not how chiropractic works. And I should say this too. Your examination we can do instead of the imaging, but the examination is only okay for that day at that occurrence. So if you come in with a severe lower back pain today, and I give you an adjustment today for that, and maybe I see you again Monday or Tuesday, and then you say,"You know what? It's gone."I filled in my questionnaire. I'm better now."Thank you doctor, you got me over this." And then let's say three, four weeks go by. And now, you feel maybe a little tightness in your shoulder, maybe you feel the other leg is a little sore, and maybe you feel that lower back again. Well, we have to do a whole nother exam and bill you again for another exam; where the X-rays are good for 12 months. After 12 months, we have to take new ones or have new ones. So that's the way Medicare works. And again, every time there's an exam, we have to recharge you. Every time there's an X-ray, we have to recharge you out-of-pocket because Medicare won't cover the expense. Now, like I said, many people wanna challenge me with this, and it's not true. A lot of people will call Medicare and say,"Hey, do I have to have an exam?" Medicare will say "No." They'll call Medicare, "Do I have to have X-rays?" Medicare will say, "No." The question is, you call Medicare?"Do I have to have an X-ray or an exam," then the answer is "Yes." But Medicare tends to always make us look like we're lying to you. But this is the way it is. Now, why do I know this so well? I know this very well because my grandfather, Dr. Bob Hulsebus, was at the table when the Medicare law was written in the late'90s, early '2000s. Medicare came after my father, said he was doing fraudulent things. My father went to Washington, DC, testified on Capitol Hill in front of congressional committee. And he was able to prove that he knew what he was doing, what we're doing here was fair, and ethical treating, and he was just being harassed by Medicare. Myself, my grandfather, and my and my dad were all the Medicare chairman of the International Chiropractic Association. And I've also been the legislative chairman involved with my grandfather. So even yesterday, I had a chiropractor calling me about Medicare laws. So we feel pretty confident we know what we're talking about. So when your family doctor might tell you,"That can't be true, the chiropractor must be wrong," I assure you just like Ask the Chiropractor, we know more about chiropractic Medicare laws than your family doctor knows. And just because it doesn't feel like it's right, again, we're dealing with a insurance agency here. You have to omit all logic. If you have logic in there, it's not gonna seem right. But if you get rid of the logic, it makes total sense. So don't let anyone tell you that that's not how it works. Some chiropractors are doing it and it works great. You don't have to do an exam, you don't have to do the X-ray. It works great for those chiropractors. They get through it, until your first audit. (laughs) When that first audit comes and Medicare says,"What in the world's going on over here," they tend to have to reimburse everything. And they don't have to reimburse it because you sign paperwork that says you have to reimburse it. So they come back after you. So make sure that your chiropractor, if you see a chiropractor, is well-rehearsed in these laws, in these regulations. Most of us in the International Chiropractic Association know these rules pretty well. So if you're looking for a chiropractor, chiropractic.org might be a good place to start looking for one, but there you have it. So remember, if you have a question about chiropractic or chiropractic care, in this case the coverage of chiropractic or chiropractic care, you should always ask a chiropractor. Because we're the ones that, well, that's what we do. We're the experts. Again, medical doctors, I have dealt with more than one. Medical doctor tell me, "What I'm saying can't be right." I just ask them,"How many Medicare claims they've done under chiropractic?" They've said "Zero." I said,"I've done thousands and thousands of them"and I've survived every audit, every investigation." So I'm pretty sure I get a good grasp of what I'm talking about compared to them. Just like if you had a question about your healthcare with a medical doctor,"Hey, should I see the chiropractor with this neck problem," Don't ask the medical doctor. They don't know, ask the chiropractor. And when it comes to the insurance, don't call your insurance company, call the chiropractor. They'll tell you the reality of the situation with the insurance. Like I said, sometimes the out-of-network is cheaper than the in-network. So call the chiropractor clinic, find out. Don't let the fact that the chiropractor is not in your insurance book stop you. A lot of times, like I said, it's because we're not in that insurance network because one, they're never gonna give you a visit anyways. Or two, they're more expensive than if we were, than being out of it. So we're out of it because it's cheaper for you. There you have it. Well, if you got a question for me, head over to my website at Rockford DC, R-O-C-K-F-O-R-D-D-C.com. You can leave a message there for me or leave a message below wherever you've seen this. If you like these videos or this podcast, there are videos and podcasts that go back and forth. Usual suspects, YouTube. Anywhere you can find a podcast, you can find me. If you go to my website, under Blogs, we list all these. So you can go back and see the library of 'em. There's a search button. So you can look for the topic you're looking for. Thanks, everybody. Have fun.