Understanding Chiropractic Insurance: A Comprehensive Guide

Ask the Chiropractor-
This week our staff gave me the second most asked question they receive on the phone prior to a patient starting care.  #healhty815 #icachiropractor #palmerproud

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Transcript

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- 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 Ice Hogs. Let's dive into it. Hi, Dr. Brant Hulsebus again, and welcome back to my podcast. Again, my podcast is for people who have questions about chiropractic or chiropractic care, the only person qualified to answer always is a chiropractor. So last week I did part one, this is part two of a two part series, I guess. And normally patients ask me questions or somebody out in the public will ask me a question, and now more and more other type of healthcare providers, whether it's a strength conditioning coach, whether it's a yoga teacher, even primary healthcare doctors or orthopedic doctors ask me questions, which I love, right? But this question's came from my staff. My staff, we had a staff meeting and they wanted to gimme the two top questions they get asked on a telephone all the time about people before they come in. And if you didn't catch last week's, go ahead and go back and listen to it. It's about how many times do I have to come for whatever. Everybody wants to know,"Hey, if I have a headache, how many visits does it take to get rid of my headache?" And I go over all the complicating factors, both positive and negative that I could think of that would affect that answer and then why your chiropractor should give you a schedule, and if your chiropractor is not giving you the answer to that question, then I would question that chiropractor and maybe ask a different chiropractor to review your file and your X-rays and stuff. But let's go on to part two today, okay? So part two is the question we get asked all the time about whether or not we're primary access. What do I mean by primary access? Can we come in and use our insurance or Medicare or do I need a referral to come see you? So I'm in Illinois and I'm an expert on being a chiropractor in Illinois. I'm not an expert at being a chiropractor in say, Arizona, Hawaii, Massachusetts. So I'm just going to answer how I can answer you in Illinois. And I believe the answer is the same everywhere. So the answer is, do I need a referral to come see you? Well, your individual insurance policy might ask for that, but the answer to the legal answer is no, you do not. Chiropractors are unique and distinct is that we are primary healthcare providers. So just like you can go see your family doctor without having somebody give you permission or walk into an emergency room without having to have authorization first, chiropractic has established itself as a primary healthcare provider. So you do not need to have a doctor's permission to come see us. Frankly, you'd never see us. So no, you can just walk into a chiropractic clinic, you don't have to have prior authorization, nobody has to tell you to go first. Now, in many states, and until recently here in Illinois, if you wanted to go see a physical therapist and have your insurance cover it, you had to go see a physician first, and the physician had to refer you. Chiropractic hasn't been like that, I don't know that it ever was like that, but no, chiropractic does not, you don't need that. And a matter of fact, your chiropractor can write the note for your physical therapist in most cases, so yeah, not only, we can refer to other healthcare providers too. Now, in Illinois, again, I'm talking about Illinois 'cause I'm the expert in Illinois, I'm not the expert in Wisconsin. If you're involved in a work comp claim, let's say an auto accident or you got hurt at work, then different laws kick in. I know like for a workman compensation claim, where I got hurt at work, you're allowed to pick any one doctor you want to and then that doctor can then refer you to more doctors. But you can't just be going doctor, doctor, doctor, doctor. You have to pick one and then that one will send you everywhere you need to go. And that one can be a chiropractor. You can start at the chiropractic clinic. But if you got hurt and you went to the emergency room, then your emergency room doctor now became the first doctor in the chain. Now that doctor could send you to your primary. Now that's okay because the first one sent you to the primary, then the primary could then send you to the chiropractor. You didn't break any rules there. But you can't just make appointments on your own in a work comp case, you have to actually start with one and follow that chain. I once had a pregnant woman who was for work driving a car and got hit and so she went to the emergency room first to make sure her baby was okay. Then she went to the OBG, excuse me, she went to the emergency room first because she got a car accident, then she went to her OBGYN because she's pregnant, wanted to make sure her baby was safe and then she came into our office. Well, there's three different doctors she picked on her own. Now luckily I knew the ER doctor we called and the ER doctor then made the necessary referrals. But you can't just keep going doctor, doctor, doctor, you have to follow a path. You have to check on that in your own state. How do you check on that in your own state? Call your chiropractic state association, ask them, they should know the answer to that. I'm proud to say the Illinois Prairie State Chiropractic Association knows how to answer to that question, so call the state association and ask them the answer to that question. But let's just say you're just going on your own. You're not an auto accident or work comp or nothing like that, you're just going to go in as a patient, walk on in. Now how does the insurance work for that? Well, most healthcare insurance does not cover what they call like maintenance care, like I want to come in, now some do, more and more are doing it, which is awesome. But most of them do not cover what we call maintenance care, where you go in like once a month, once every two weeks, just for tuneups. They cover what we call injury care. Hey, I hurt my lower back, I'm in pain. Which is how most new patients start a chiropractic clinic. So yeah, you can go in as a new patient and your insurance should cover the injury. Make sure you explain to the chiropractor how you got hurt and what hurts and what you could do before and what you can't do now and how long it's been bothering you and your insurance should cover that. Usually whatever your policy or plan is, you have a deductible, you have deductible. If you have a copay, you have a copay, just like you would anywhere else. So most major insurances do that. Now, there's a lot of insurance companies, chiropractors don't work with because they reimburse us at a ludicrous rate. You know, like Illinois Medicaid used to give us like 35 cents to see a child and we had to do paper records and it cost like two bucks to mail it in. So we're not going to do that because we're just going to lose money. So if your insurance plan is reasonable with chiropractors, most chiropractors will be in your insurance plan. And that's going to vary state to state to state, what's good in Illinois, it's not good In Minnesota, it's not good in Michigan, it's not good in Wyoming. So you have to really, again, talk to maybe the state of association or that chiropractor. So that's kind of how your health insurance works. And different states too, with Medicaid is different state by state. For a long time chiropractic had benefits in Medicaid in Illinois and then it went away, one governor came in and said no more. And the next governor came in said, let's put it back. The next governor could says no more. It changes so much I don't even try to keep up on it anymore, but, so you want to go ahead and investigate that on your own. But if you have it and it's covering your state, you can go in and do it. Let's talk about Medicare now. My grandfather was at the table when he wrote the Medicare law. In the late 1990s, early two thousands, my father testified on Capitol Hill against Medicare. I've been the Medicare chairman of the International Chiropractic Association. So I know a little bit about this. And let me tell you how Medicare works. Medicare is supposed to cover your chiropractic adjustment to remove the subluxation, which is when two bones are misaligned, the stress, through the nerve hits the stress, the body part suffers. Chiropractic for Medicare is removing the subluxation, adjusting the subluxation, that's all they cover. So if you have a chiropractor that does a lot of physical therapy, modalities and stuff like that, it's not going to cover that. It only covers the true raw chiropractic adjustment, nothing else. However, Medicare requires proof that you need to be there. Medicare does not require an X-ray, Medicare does not require an exam. But if you get an audit from Medicare, you have to prove that those reason need to be there. And Medicare accepts an exam or an X-ray as proof to be there. So if you don't have an exam or an X-ray, Medicare could be upset with you, deny your care. When you have an exam, when you have an X-ray, I have learned that Medicare likes that and Medicare is more happy to cover your care. So if you call Medicare and say, do I have to have an X-ray? The answer's no. If you call Medicare and say, do I have to have an exam? The answer's no. If you call Medicare and say, do I have to have an X-ray or an exam, you might get a different answer. But that's what we've discovered as chiropractors. Now again, even though Medicare's a federal program, state by state the carrier's different. So how many times can you come see a chiropractor? Well, according to the letter of the law, it's as much as you need, it's unlimited. But we know in certain states, once you hit a certain threshold, you're going to have to go in front of a judge and argue why the patient's there. Our clinic has done that many times, but we kind of find like we kind of get to know what the limits are, but then you get a new carrier a couple years later and things change. Since I've been a chiropractor here in Illinois, I think we're on our third carrier. So it'll change, it'll be different. I know some states, chiropractors say working with Medicare is impossible because of the carrier, other states it's not so bad. It also depends on whether or not the chiropractor's doing all the necessary paperwork. That's one of the things that my father investigated and was able to help chiropractors defend themselves by learning what the actual necessary paperwork is. So if you have Medicare, can you go with a chiropractor? Yes. If you have X-rays from somewhere else, say you went to your primary first and you said,"I got some lower back pain." Your primary took X-rays of you and said,"You know what, this is a chiropractic case." Again, this is a very fictional story, that rarely happens. But the medical doctor goes,"You should really go to a chiropractor for this, they have the best results according to the North American Spinal Society." He gives you a copy of your X-rays, you bring them to the chiropractor, the chiropractor can then use those X-rays to start your care. So even though they're not covered at a chiropractic clinic, they are covered at your primary, and so if your primary takes those X-rays, we can use those. Unfortunately, your primary usually, 99.9% of the time, your primary does not know how to do a chiropractic exam. They know how to do orthopedic tests, they know how to do lower back tests, but they do not know what a chiropractic exam is, why? They're not a chiropractor. So a chiropractic exam could be a little different. So usually we can't always use all their exam findings like maybe a physical therapist's could, but we can use the X-rays because X-rays are X-rays. So as long as you're standing chiropractor can use those X-rays, standing when the X-rays were taken, we want to see in a weight bearing position, it helps us analyze your spine chiropractically. So there you have it. So can I use my insurance? Yeah, as long as you tell us about it's an ache or pain, it's not maintenance. Can I use Medicare? Absolutely, as long as you tell us about how your pain interferes with your activities of daily living and we have proof either an exam or X-ray, the X-rays are good for one calendar year typically. Could I use my auto, I got an auto accident, can I come see you? Yeah, that's easy, that's a no brainer. I am involved in a work comp, can I come see you? Well, have you seen somebody else already? No, come on in. Yes, then we need to get a referral from that other doctor before we can see you in Illinois. Again, I'm quoting Illinois laws, I practice in Illinois, I have not learned the other 49 states laws. But again, you can go to chiropractic.org, that's the International Chiropractic Association, and they can help find those answers or you can find the state association for those answers also. So there you have it. That's kind of how it works. And the only time you really need a doctor to tell you that it's okay to come in is in a work comp claim, other than that, you're just walking off the street and most chiropractors can help you. So there's your questions, there's my answers, I hope I answered them for you well enough, other than that's stay healthy, stay strong, and if you have a question about chiropractic, go to RockfordDC, R-O-C-K-F-O-R-D-D-C.com and I'll be able to answer your questions next time, maybe you'll be the next podcast. Again, this is part two of the most common questions my staff get asked, if you'd missed part one, go back, take a look at it, other than that, stay healthy, stay strong. We'll see you next time around, thanks for listening.