Q: How is Medicare different in a chiropractic office?
A: Medicare coverage is different in a chiropractic office than in your medical provider’s office. Chiropractors are required to document your visit using up to three different types of codes, each of which represents a different procedure that was performed in the office that day. There is a separate code to report new evaluations for new conditions or ones following some type of injury, there is a code to represent the adjustment portion and there is a code to represent each individual therapy service that you may receive (for example, Electric muscle stimulation or stretching). Medicare covers 80% of ONLY THE ADJUSTMENT CODE. All other services are considered non-covered services and are your responsibility. These are only covered if you also have a SECONDARY insurance plan. Most additional plans are SUPPLEMENT plans. This will cover the remaining 20% of ONLY THE ADJUSTMENT CODE.
Q: What are the different types of Medicare coverage?
A: There are 4 possible scenarios for a Medicare patient, and they are as follows:
- Medicare Only – Medicare pays 80% of the adjustment portion of the visit. You are responsible for the remaining 20% and in full for any additional, non-covered services (Electric muscle stimulation, stretching, traction, examinations, extremity adjusting, etc…)
- Medicare and a Supplement – Medicare pays 80% of the adjustment portion of the visit. Your supplement pays for the remaining 20% and in full for any additional, non-covered services (Electric muscle stimulation, stretching, traction, examinations, extremity adjusting, etc…)
- Medicare and a Secondary – Medicare pays 80% of the adjustment portion of the visit. Your secondary pays for all other services.
- Medicare Advantage/HMO – Medicare pays $0. The insurance company(UPMC, Blue Cross, Advantra, Cigna, etc.) listed on your card is responsible for administering your benefits. They will typically have a copay associated with your plan. You are responsible for the copay each visit and for any additional, non-covered services (Electric muscle stimulation, stretching, traction, examinations, extremity adjusting, etc…). These types of plans are NOT secondary insurances for Medicare.
Q: Do you fill out disability or FMLA forms?
A: No. We are sorry but these forms are very time-consuming and we don’t have the resources to do so. Requests have been overwhelming for disability, AFLAC, FMLA, Short-term disability, Handicap Placards, etc. We will provide excuses for missed work and for missed school. We will also provide you with a copy of your paid expenses at the end of the year for you to pick up. However, if you must have a form completed, it will be treated as a self-pay visit and will cost $80 for the form to be completed, provided it takes 15 minutes or less to complete. Our office will not mail these forms.
If you have questions or need some clarifications please feel free to call us at (724) 941-5805.
