If I had a nickel for every time someone asked "Does my insurance cover chiropractic care?" I’d be able to retire early! This is a question that all healthcare providers have struggled with for years. Unfortunately, when it comes to insurance, coverage often varies between payers — even varying between plans for a single payer. The increase in high-deductible plans has only compounded the issue because even if it is covered, they might still have to meet their deductible.
The following Q/A, which is found in Appendix C of the ChiroCode DeskBook, provides some guidance:
Question: We are having trouble communicating insurance coverage details to patients. Do you have any suggestions?
Answer: First, you should make sure your insurance verification is complete and properly detailed on the Verification of Insurance Coverage Form (Resource 148). It can be helpful to provide the patient with either an Estimate of Medical Fees (Resource 147) or a completed copy of the Verification of Insurance Coverage Form. It may also be helpful for them to contact their insurance company to obtain answers regarding coverage.
Another suggestion is to provide a patient financial consultation where a staff member goes through the Estimate of Medical Fees with them. It doesn’t have to take more than a few minutes, but should allow them the opportunity to ask questions so they understand their financial responsibility. A consultation is an effective way to communicate the payer’s coverage verification disclaimer which typically states something like, “There is no guarantee of coverage as coverage and benefits are not determined until the claim is received and processed.” It is important for patients to understand that they are ultimately the ones responsible for the financial aspect of their healthcare.
This complex topic is covered in more detail in the “Establish Patient Financial Responsibility” segment found in Chapter 1.1 — Insurance & Reimbursement Essentials of the ChiroCode DeskBook.