Why Don't You Take My Insurance?
/This is one of the first questions that gets asked when new patients are looking to schedule an initial appointment at a healthcare providers office. Insurance has been a hot topic for years and it can be confusing and overwhelming. With a language of its own, words like “deductible”, “co-pay”, “out-of-pocket”, and “HSA” can result in the immediate glazing over of eyes.
People pay a lot of money towards their insurance premiums, so naturally they want to utilize what they’re paying for… but is using your insurance always the most cost-effective option?
With insurance premiums continuing to increase, more and more people are switching to policies with the most affordable premium, a high deductible health plan. For 2024, according to the IRS, “high deductible health plan” is defined under § 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,600 for self-only coverage or $3,200 for family coverage [4]. A study conducted by the CDC, showed that from 2007 to 2017, enrollment in high deductible health plans with a health savings account (HSA) increased from 4.2% to 18.9% and without an HSA from 10.6% to 24.5% in adults aged 18-64 [2]. This means that while people are saving on their health insurance premiums, they’re paying much more out of pocket before insurance actually kicks in to cover anything.
So where does your chiropractic care fit into this equation?
Some insurance companies and policies do allow for chiropractic care to be billed. Typically these policies will permit between 12-20 visits to be billed per year, based on “medical necessity”. Keep in mind, this is all based on what the insurance company deems medically necessary, not what you or your provider believe. If you have a high deductible health plan in which your policy allows chiropractic care, these visits can be billed by an in-network chiropractor. But here’s the kicker… just because those chiropractic visits are being billed to your insurance company doesn’t mean that they are the ones paying for those visits! If you have not met your high deductible (shelled out anywhere between $1600 - $6000) you will be the one paying for your chiropractic care and it is simply being applied towards your deductible. If, and when, that deductible is met, then your insurance company kicks in and starts paying whatever percentage of cost that has been agreed upon in your policy, which typically ranges anywhere from 50-90%.
Speaking of paying, the insurance company also determines the exact amount that will be paid for a service. Each insurance company has a set “allowed amount” for any billing code submitted by a provider. What this means is if a chiropractic visit is being billed towards your deductible, you will be paying anywhere between $65 - $125 depending on what services were billed by the chiropractor.
I share all of this in hopes of better explaining why, at Renew & Restore Wellness, we are not in-network with any insurance companies. Here are the three primary reasons why we don’t take your insurance:
1. We are able to pass savings along to our patients.
Healthcare is expensive and can have a huge impact on decisions that families have to make. A report produced by Kaiser Family Foundation found that 25 percent of workers say they, or an immediate family member, struggled to pay their medical bills before meeting their deductible over the last year. The report also found that 26 percent say they cut back spending on food, clothing and basic household items to pay for healthcare costs. [3]
Billing insurance comes with additional costs for the provider as well. It typically requires additional time and/or staff to submit and process insurance claims as well as follow-up on any unpaid or unprocessed bills.
By cutting out the middle man (insurance) and eliminating these costs, we are able to offer our services at a much more reasonable price than if we were submitting bills to insurance. To learn more about our services and pricing click here.
And even better news… that health savings account you signed up for with your high deductible health plan? You can use it to pay for your chiropractic care with us!
2. You and our chiropractors are the ones deciding what treatment is right for YOU.
Each patient is different and your individual situation deserves an individualized approach. Since we’re not participating with the insurance company we are not restricted by what they deem medically necessary or reasonable. This allows us to provide the absolute best care to help you meet your health goals!
Not sure if chiropractic care is something that lines up with your health goals or concerns? Click here to read about five unexpected reasons to see a chiropractor.
3. You can still submit your visits with us to your insurance company on your own.
Should you wish to submit your visits to your insurance company in order for it to apply towards your insurance benefits and potentially get reimbursed, we are more than happy to provide you with an itemized receipt (called a superbill) to do so! Simply send us an email or mention it at your next visit and we will send you everything you need.
If you’re still hesitant to see us at Renew & Restore Wellness because you think it may be better to use a provider who takes your insurance, give us a call! We would be happy to help find out your insurance benefits in order to help you make the best decision for you and your family.
Resources
1. High Deductible Health Plans (HDHPs) & Health Savings Accounts (HSAs). Retrieved February 17, 2020, from https://www.healthcare.gov/glossary/high-deductible-health-plan/
2. (2018, August 1). High-deductible Health Plan Enrollment Among Adults Aged 18–64 With Employment-based Insurance Coverage. Retrieved February 17, 2020, from https://www.cdc.gov/nchs/products/databriefs/db317.htm
3. (2019, June 4). Report shines a harsh light on the cost of high-deductible plans to consumers. Retrieved February 18, 20202, from https://www.healthcarefinancenews.com/news/report-shines-harsh-light-cost-high-deductible-plans-consumers
4. https://www.irs.gov/pub/irs-drop/rp-23-23.pdf