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Commercial
HealthCare Insurance Questions
Q: Are the doctors at LPFC on my insurance
plan?
A: The Doctors of LPFC are preferred providers
for most major health insurance companies, including United Health
Care, PHCS, Aetna, Blue Cross Blue Shield, Cigna, BeechStreet, GPA, and
many others. We are continually adding new plans, so if you do not
see yours listed, just call our office and ask a staff member.
Q: How do I know if my plan covers
chiropractic?
A: Many health insurance policies have some
type of chiropractic coverage. Regardless of whether we are in or
out of network with your carrier, we would be happy to verify your
coverage and determine what, if any benefits you may have. Just call
our office with your insurance card in-hand and we will do the rest.
Q: Will LPFC file my insurance claims?
A: Yes, as a courtesy, we will file all
insurance claims. However, if you would like to file your own
claims, just let us know and we will provide you with the proper
paperwork
Q: What is the difference between an HMO,
PPO and POS?
A: An HMO (Health Maintenance Organization) is
a prepaid health plan in which providers are reimbursed at a fixed
fee to treat patients covered by the plan. In some cases the
insurance company may require a referral from a primary care
physician (PCP) to see a chiropractor.
A PPO (Preferred Provider Organization) is a health insurance
program that contracts with providers who agree to provide health
care at a discounted fee. These providers are Preferred Providers
considered in-network. PPO plans allow members to see any provider
of their choosing. However, the level of benefit is usually
different if they see an in-network provider versus an
out-of-network provider. There is usually a co-payment for
in-network provider, and often a percentage of coverage once a
deductible is met for out-of-network providers. The specifics vary
according to the policy.
A POS (Point-Of- Service) plan is a health insurance plan that
allows patients to seek treatment from the HMO plan’s providers, OR
to use providers outside the plan at a higher co-payment or
co-insurance level.
Q: What is a provider?
A: A provider is doctor that provides
services.
Q: What is a co-payment?
A: A co-payment is a policy set dollar amount
that a patient will pay per date of service or even per type of
service. There are some policies that have different co-pays for
different services; i.e. chiropractic services can be considered a
specialty service, therefore there could be a different co-pay
amount for specialist office visit then for a primary care physician
office visit. A co-pay can vary between $5.00 and $50.00 depending
on the policy.
Q: What is a deductible?
A: A deductible is a dollar amount that must
be met by the member each benefit year (usually the calendar year)
before the insurance starts paying for services. Once the deductible
is met, then a percentage of reimbursement (co-insurance) will be
paid by the insurance company to the provider. Deductibles can range
between $100 and $1000, and are usually higher for out-of-network
providers.
Q: What is co-insurance?
A: Co-insurance is a percent of reimbursement
that insurance pays the provider after the member’s deductible has
been met. However, deductibles are not always standard with
co-insurance, some policies do not have a deductible that must be
met first. The percentage that insurance covers varies according to
the policy. Percentage of coverage is usually anywhere from 40%
coverage to 90% coverage.
Q: What does out-of-pocket mean?
A: Out-of-pocket (OOP) is the dollar amount
each benefit year that a member pays out of his/her own pocket for
expenses the insurance company did not cover, or expenses that were
only partially paid. Once the member has met their OOP, the benefit
level for all covered services becomes 100%, and the member is not
responsible for any additional OOP covered expenses for the
remainder of that benefit year.
Medicare
Questions
Q: What is Medicare?
A: Medicare is a federal health benefit
program for the elderly and disabled. Chiropractic is covered under
the Part B portion of the program. Medicare covers the manipulation
of the spine at 80%, and typically allows 12 visits per year.
Q: What is supplemental insurance as it
relates to Medicare?
A: Supplemental insurance policies are used
with Medicare to cover the remaining costs of services that Medicare
does cover. (For example, the deductible and remaining 20% of spinal
manipulation.)
Q: What is secondary health insurance as it
relates to Medicare?
A: Secondary policies cover all remaining
services (according to the individual plan) that are not allowed by
Medicare Part B. It also pays the remaining percentage of covered
Medicare services. In many cases, these policies were already in
effect prior to when Medicare benefits started.
Questions
related to Accidents and Injury
Q: Should I see a chiropractor following an
automobile accident?
A: When in an auto accident, it is important
to have a chiropractic exam to determine the extent, if any, of soft
tissue or spinal injury.
Q: How do I pay for medical expenses
related to an automobile accident?
A: Personal Injury Protection (PIP) Insurance
is the most common type of insurance used to pay for medical
expenses related to accidents, regardless of fault.
Q: What is Personal Injury Protection (PIP)
Insurance?
A: PIP is insurance that is not required by
the state of Texas, but is automatic on all policies written in
Texas unless denied by the policyholder in writing. Therefore most
car owners carry PIP on their automobile policy even if they are not
aware of it. This is coverage that you pay for each year and its
purpose is to allow for the timely treatment of injuries, without
using up your commercial benefits, and without having to worry about
paying for treatments out-of-pocket. The coverage can be utilized
immediately, it is available per incident, and does not require a
referral. You are allowed to see any doctor of your choosing. PIP is
usually available at $2500, $5000 or $10,000 and covers the
authorized driver of the vehicle, the owner, all members of the
owner’s family and anyone riding in the vehicle at the time of the
accident.
Q: How do I activate my PIP benefits?
A: If you have been in an accident and would
like to activate PIP benefits call your auto insurance agent or
company and file an “Applications for Benefits” form. You just need
to inform your agent of the accident and tell them you would like to
open a claim for medical expenses. If you need help with this
process, please call our office and we can help guide you through.
Q: What is liability insurance?
A: Liability insurance is another type of
insurance that is paid for by the party at fault for the accident.
The statute of limitations is 2 years. Claims filed against
liability coverage will commonly result in a rate increase for the
insured. Payment is usually suspended until all treatment is
completed, and fault has been agreed upon between the insurance
companies involved. This type of coverage may be risky for the
doctor because payment may be suspended for years while the
insurance companies duke it out. |
