Insurance policies are an arrangement between the insurance company and the patient.
Insurance company may pay less than the actual bill for services.
The information that our office receives on your coverage is not a guarantee of payment and may change at anytime.
We receive to the best of our knowledge information on your coverage but it is your responsibility to verify all insurance information.
You need to agree to be responsible for payment of all service rendered on your behalf or your dependents not covered or denied by my insurance company.
Here is some basic information on different insurances and what they might cover.
This coverage may change at anytime.
Blue Cross Coverage
|Blue Care Network||We are IN Network for BCN. You will need a referral before your initial visit. Without a referral, patient has to pay up front all charges. BCN DOEScover chiropractic as long as you have a referral. We have a list at the front desk of Doctors that refer to Van Every all the time. New Patient Referral Info :Download this and take it to your Primary Doctor to get your referral information.|
|Federal Blue Cross||Basic option covers physical therapy, up to 20 adjustments and initial x-rays.
Standard option covers physical therapy only.
|GM Hourly Traditional||Covers x-rays only. Bill insurance for x-rays; patient’s pay upfront for adjustment visits.|
|X-Rays Only or Basic||Covers x-rays only. Bill insurance for x-rays; patient’s pay upfront for adjustment visits.|
|Master Medical||The Traditional portion will cover x-rays, and pay us directly. The Master Medical (MM) rider will cover 20 office visits in ninety days (whichever comes first) for an acute condition. MM will cover 2 visits per month for a chronic condition. The coverage starts over with each acute condition. ***Note: some MM policies do not have visit limits, however, since it is a subscriber policy, we cannot obtain actual coverage until we get the EOB’s. Therefore, will bill until we reach the maximum, in case of this scenario.*** MM pays the subscriber, instead of the provider for office visits. Covers physical therapy even when adjustment is not covered. Patient pays the entire amount up front and will receive a check from their insurance company for the covered amount sent directly to them. The patient usually will have a 20% Co-pay.|
|Community Blue||Part of the Trust Program. Covers x-rays, 24 office visits, and up to 60 physical therapy. Benefits restart at the beginning of each calendar year. The patient will have some type of Co-pay.|
|Comprehensive Major Medical||Covers x-rays, 38 office visits per year, and physical therapy. Benefits restart at the beginning of each calendar year.|
|State of Michigan||Covers x-rays, usually 24 office visits (modify if necessary), and physical therapy. Benefits restart at the beginning of each calendar year.
“MESSA” Covers x-rays, office visits and physical therapy. Benefits restart at the beginning of each calendar year. Will reimburse for supports. Note that there are now different tiers of coverage.
|Blue Choice||Covers x-rays, usually 20 office visits (modify if necessary) and physical therapy. Benefits restart at the beginning of each calendar year.|
|Blue Preferred||Covers x-rays, usually 26 office visits (modify if necessary) and physical therapy. Benefits restart at the beginning of each calendar year.|
|Meijer Primary Care Plan||No Chiropractic Coverage.|
|Medicare Option 1, 2, 3||Option 1 $20, Option 2 $20, Option 3 $10 – Medicare covered services only.|
- Blue Cross Blue Shield of Michigan
- BCBSM Trust Program—Community Blue, Blue Preferred, MIChild • BCBSM PPO’s • BCN (Dr. Saylor) • Regular Medicare (not “Medicare Prestige Plus” or any other HMO)
- PPOM • PPOM affiliates: Aetna, Teamsters, AAA, Humana, etc. This list changes often.
- For ALL other insurance plans, we are OUT-OF-NETWORK, including BCBS Blue Choice POS, United Healthcare, M-Care, ACN. Unless otherwise stated. Please call us to verify.
Medicare (Not Medicare HMOs)
Medicare is a federally funded health plan that provides benefits to anyone over 65 or disabled. The widow of a qualifying spouse is also covered. Part A provides hospitalization coverage (not useful for us). If a patient has Part A or “Hospital Benefits,” ONLY, they do not have chiropractic coverage. Part B provides adjustment visit coverage (no x-ray or physical therapy coverage). If a patient has supplemental coverage and is still working, Medicare coverage is secondary.
The Beneficiary Medicare Number is comprised of the social security number followed by a beneficiary identification code (BIC), which helps identify the relationship to the beneficiary:
Suffix A—Wage earner
Suffix B—Spouse of wage earner
Suffix C—Child of wage earner
Suffix D—Widow of wage earner
If the Medicare number has a prefix instead of a suffix, the coverage is different and policy has other guidelines.
Medicare patients must sign an ABN form (Advance Beneficiary Notice) which allows us to charge patient for services not covered by Medicare. Visits rejected by Medicare cannot be charged to the patient without this notice signed. Medicare will cover at least 20 office visits each year.
Medicare patients have a $135 (as of Jan. 1, 2008) deductible per calendar year. Our insurance expert will assess deductible charges when the EOB is received. It’s important for Medicare patients to understand that they would be charged a deductible regardless of where they receive care, most supplemental policies do not cover the deductible and that once it’s paid each year, they will not be charged for it elsewhere. Patient also will have a co-pay for each visit.
For any patients turning 65, we encourage them to sign up for Medicare even if they are not retiring or signing up for Social Security. It is a good idea to sign up during Medicare’s initial enrollment period, which begins three months before their 65th birthday. This is because after age 65 Medicare Part B medical insurance could be delayed and their premiums may be higher. (BCBSM The Record, June 2003)
Medicare with supplemental coverage
Find out if the supplemental coverage covers x-rays and/or co-payments and/or deductible when verifying coverage. Keep in mind that the supplemental policy may have its own deductible, as well.
We do not accept Medicaid.
This includes all commercial policies like Aetna, Cigna, etc. We deal with over 900 policies at any given time, so we need to verify carefully after receiving your insurance information. Typically, benefits have either a limitation on the number of visits paid per year or a limit on the dollar amount of benefits paid per year. Coverage depends on your specific policy.
Most HMO’s will not cover chiropractic care unless the policy has a chiropractic rider AND the patient obtains a referral from their medical doctor. In other words, if a referral is attained, verify policy to make sure that chiropractic is actually a covered service.
In our area, neither Care Choices HMO, nor HAP HMO has a chiropractic rider available.
We do participate in the HAP ACCESS program which offers a discount to patients with HAP. Patient’s pay at the time of service.
Click Here for a list of questions to ask when
you call your insurance company for your chiropractic coverage.