Medicare has very strict rules when it comes to what they will cover when it comes to chiropractic care.
They see chiropractic care as a way to fix a specific problem and not so much of a long-term way to improve existing conditions and prevent other problems from developing.
They do not cover routine or maintenance visits; there has to be some kind of situation for it to be considered “Active Treatment.”
Some examples of what they would consider active treatment would be a fall, injury, or sudden onset of symptoms (like if you woke up and couldn't move your neck.)
Medicare covers a limited number of visits in the case of an active treatment situation. If such an incident occurs, our doctors will have you fill out paperwork at the beginning and end of these "active treatment visits."
You will still be expected to pay for these visits at the time of service, but any reimbursement from Medicare will be sent to you directly.
Medicare does not allow chiropractic offices to charge more than a certain amount for spinal adjustments. The price varies based on how many adjustments are received, as well as if the adjustments are considered active or maintenance care. As an office, we will charge you based on Medicare’s limiting fees, which may change slightly from year to year. These prices will apply to all Medicare patients; it does not matter if you prefer to have your claims submitted or not.
Medicare does not cover extremity adjustments, so any fees related to adjusting your extremities are your responsibility, even during active treatment.
There may also be additional x-rays or exams scheduled around the beginning and end of these visits to determine the severity of the injury and the amount of improvement received.
Medicare does not cover any x-rays or exams if they are performed at a chiropractic office.
We are an out-of-network provider, and while we do submit claims to Medicare, this may be the reason some have expressed experiencing more coverage at another provider (that may be in-network).
Claims are submitted every 2 weeks.
We do send claims for Medicare Advantage Plans, in addition to traditional Medicare. These advantage plans, such as Aetna Medicare or United Healthcare Medicare, may have their own rules about what they will cover. They do not necessarily follow the same guidelines as traditional Medicare.
If you have a secondary policy, Medicare will forward the claims on to the secondary carrier.
Occasionally, secondary insurance will cover part of the cost of care, but there is no guarantee. Many plans will not pay if Medicare does not, which is the case will all our chiropractic visits unless it is active treatment.
If we receive any payments from Medicare, a secondary insurance company, or a Medicare Advantage Plan, the payment will be applied to your account, resulting in a credit. Insurance credits can either be used to pay for future care or returned as a refunded amount.
