About Your Insurance And Chiropractic Care

Insurance is confusing. Especially when it comes to coverage.

If a doctor is “in network” that means that they have a relationship between the patient, the doctor and the insurance company in the a somewhat strange relationship. The patient pays the insurance company. However, it is the doctor and the insurance company that have the contract that dictates the patient care. Insurance tries to tell the doctor when it is appropriate for re-exams, treatment and closing out care. This harms the doctor patient relationship because the doctor may not be able to give the patient what they need because care is dictated by the insurance company. The purpose of the “in network” relationship is to SAVE money for the INSURANCE company. It is not to save money for the patient.

The term “In network”  as used by insurance companies, is basically a way for costs to be managed by the insurance company. Being an “in network preferred provider” for Blue Shield for example, we have to sign a contract each year in which we agreed to limit procedures and visits in order to cut costs for the insurance company. This can cut care plans short because the patient does not want to pay any further costs out of pocket.  Does that sound like it is in the best interest of the patients? We did not think so. What this means is even though your actual  Blue Shield insurance policy benefits may say  you get “20 chiropractic visits per year.”   Your insurance can stop paying because they don’t think it is medically necessary and we won’t find out that visits aren’t covered until the visits are already used. So, what this means is that you don’t have the insurance that you thought you had and are paying out of pocket for such visits.

The old fashioned way of insurance policies really utilized the patient/doctor relationship. The contract was between the patient and the insurance company as it should be. The doctor is not involved with the insurance company. Doctor prescribes best care and focuses only on that. Patient decides if they want the care. Patient pays insurance company. Insurance pays patient and patient either pays the doctor in full with cash or brings in the insurance check.

In the new, in network design, the doctor is obligated by their contract with your insurance company to limit visits.  For example, Kaiser Permanente they limit all coverage to 5 visits per year as an average. This is without even knowing about injuries. If patients go past 5 visits, enormous paperwork is involved with information begging for more visits.  If not approved, those visits will not be covered under their policy and the patient will have to pay for each visit not covered.  This occurs normally AFTER the visits have already been used.

If you are a chiropractic patient and your policy says you get 20 visits per year and your chiropractor tells you they can only bill 6 for you and you are in pain, how would you feel?  Most patients do not like this one bit and it was very hard for them to understand, especially if they clearly needed more visits. In most scenarios the patient gets angry at the doctor and their facility instead of the actual insurance company. Note: the doctor has no power or negotiation ability with the insurance company and if they are submitting billing to them, it is as a courtesy to you.

The visit limit is just one example of how preferred doctors are limited and controlled. Basically someone in a big office who has never met the patient is telling the DOCTOR what they can and cannot do for you. Telling them how many visits you can be seen. This is independent of what you may need or what you have paid for on your policy.

The bottom line?  What does this mean for you?

Your insurance coverage may actually be much better for chiropractic care if you see an “out of network” doctor.  This allows your doctor to provide the care that you and the doctor feel you need, not some adjuster that reads a piece of paper stating how much they are willing to allow you to use.

Any visits billed to Blue Cross or any other insurance company must still be “medically necessary” as most insurance does not pay for chiropractic “maintenance care even though there are many times when it is necessary. Just know that getting low cost insurance isn’t really saving you money, it is limiting your care and in most cases you end up paying out of pocket for visits that they do not cover.

High Costs of Hospital and Surgery vs. Chiropractic Care

I have heard from patients on several occasions that chiropractic care is expensive.  Health does cost money and lets look at the stats here:

Hospital and surgery costs in America was approximately $2.7 trillion in 2011.  $814 or 31% of the $2.7 trillion was spent on hospital bills.  For a one day stay in the hospital the average cost is $3,949.  Most patients average $15,734 each time they go into the hospital for care.  According to the U.S. Centers for Disease Control and Prevention (CDC), the total number of inpatient surgeries performed in 2009 was 48 million. Total spending for common hospital operating room procedures in nonfederal community hospitals was over $166 billion. These amounts don’t even take into account time off of work for rehabilitation or sickness!

So what are the top 3 surgeries performed?

1. Spinal Fusion surgery ($11.26 billion)

2. Heart angioplasty ($11 billion)

3. Knee replacement surgery ($10.36 billion)

Hospital Costs

There is no standard system that determines what a hospital can charge for any service or procedure. Hospital pricing depends on a few things, including the patient’s health circumstances, the cost of lab tests, X-rays, operating room costs and surgeries, medications, and each doctors’ and specialists’ fees.

This means that no two hospital bills are likely to be the same. So regardless of a hospital’s published fee schedules for a service or procedure, the best information that a prospective patient can receive is a good-faith estimate. Until the bill is actually processed, there is no reliable way to assess a patient’s final hospital costs.

Surgery Costs

Total payments are often broken down into hospital expenses (60-80% depending upon procedure), physician payments (13-19%), and post-acute care (7-27%).

In addition, surgery costs vary depending upon who pays for the operation. An individual who is self-paying will be charged a different amount than a private insurance company which, in turn, will be charged a different amount than Medicare or Medicaid.

For example, in 2005, the average total payment for back surgery in the United States was $26,515. But the difference between the lowest and highest payments for the procedure was $18,762. Coronary artery bypass surgery averaged $45,438, but the differential between the highest and lowest cost was $16,668. The gap was $10, 615 for hip fracture repair, and $12,988 for a colectomy.

The community in which a hospital is situated will also cause surgical costs to vary widely. In 2012, the California Public Interest Research Group (CALPIRG) Education Fund, a consumer watchdog organization, studied geographic variations in the state’s hospital charges for similar surgeries and found that facilities in California’s highest-priced region charged up to 2.7 times as much for the same surgery as did hospitals in the lowest-priced region.

So, how expensive is Chiropractic Care again?  Taking care of yourself not only saves you money in surgeries and hospital visits but it makes you feel great as well.  For each visit that you come in you may pay $65.00 per visit.  Even if you are coming in frequently, it will never equal the amounts stated above.   Take the steps that you need to stay healthy and save money!

What Is The Difference Between A Co-Pay And A Deductible?

I get a lot of patients coming in for care and they are confused about what a deductible and a co-pay are.  Here is a bit of a breakdown to help anyone understand the difference.

What is a CO-PAY?

A co-payment, or co-pay, is a flat amount paid for each visit to a doctor’s office or portion you pay for medication.   This is paid when you are seen and receive treatment, an exam or have a consultation.

Every health insurance company has different co-pays depending on the plan.  Most of the time they are printed on your insurance card.  There can be different co-pays for each profession you go to, for example, a Chiropractor is a “Specialist” and have a certain co-pay specifically for them.  A dentist may have another amount along with a Physical Therapist.  It all depends on your plan.  In addition to cutting a small portion of the costs by having you pay a portion for each visit, having a co-pay will also prevent people from seeking care for problems they consider trivial just to get the most out of the insured’s dollar or seek care for something a bandaid would be used for.

However, while the co-pay does lower costs for the insurance companies, by making people more mindful about when it is necessary to go to the doctor, It may also prevent people from getting medical attention when they may need it. For example, it can be costly for a person that has a long term problem and needs to see several doctors in a week for it or see one doctor several times a week or a month, if they have a $25.00 co-pay each time and can’t afford it, they may choose to see what happens and then the condition may worsen making it necessary for invasive treatments, x-rays, MRI or other necessary tests that can cost thousands of dollars.


A deductible is a fixed amount of money you have to pay before your co-pay kicks in and your full policy benefits can be utilized.

The amount of a deductible is normally calculated on a yearly basis and most policies restart in January and the deductible is then back up to its full amount.   Before you meet the allotted amount of your deductible, you have to pay the full price of the doctor bill.  Once you meet your deductible, then the co-pay is all you need to pay.  There are individual deductibles for single policy holders and family deductibles for families and both differ in price.

Normally, if your plan has a high deductible, it has a lower monthly cost.  So, just know that if something happens and you need care, it will be pricey.  If you are normally healthy and don’t see a doctor often this may be a plan you want to take your chances with.  However, if you are someone who is sick often, has a large family, or like to see a doctor more than the average person, you may want to get a lower deductible plan and pay a bit more each month for insurance.

A deductible is also considered an what is called an “out of pocket” expense and can work toward working this off.  In general, an out-of-pocket expense maximum is the amount you need to meet for paying for your doctor’s appointments before they will pay 100 percent of your health expenses. Normally, your deductible and coinsurance can be applied toward this maximum amount. Your co-payments or monthly insurance premiums are not included in “out of pocket” expenses.

What Does Co-Insurance Mean?

Coinsurance is used in several different types of insurance and is different depending on the type of insurance you choose. The way it works is basically instead of having a “set” amount to pay each time you see a doctor (after your deductible is paid), you instead pay a percentage for each visit.  This can be as little as 10% to 80%.  Then the insurance company pays a the remaining percentage to the healthcare provider.

Hope this helps!

If I Have Seen A Medical Doctor After A Car Accident, Should I Still See A Chiropractor?

When visiting a medical doctor after an accident, they normally take vital signs and x-ray images to make sure there are no fractures.  They also do a brief exam to  make sure there are no life-threatening conditions.  Patients are usually released with pain medications and  they are not focusing on the long term effects that can occur after an accident.  Pain may go away temporarily, but come back if the problem is not taken care of.

Chiropractors treat the body and help it heal after an accident.  They then keep a close watch on your progress to try and prevent for future problems that may occur after an accident.  So, yes, you should see a chiropractor.  Find one that has the experience and equipment to track your body (even when you are not in pain anymore).

At our Redwood City Chiropractic office, we find out if there are underlying issues that need to be dealt with to prevent problems in the future and get you out of pain quickly and do the things you love to do.

Just think, you are hit by a vehicle that weighs a ton!  This highly effects your body and it can have some future problems if not rehabilitated properly.

Call Dr. Gregory today and set up an appointment, your body will be glad you did!

Does Health Insurance Cover A Car Accident?

You may have great insurance to cover the costs of your car repair but not carry adequate medical coverage on your car insurance policy.

Most people assume that health insurance will cover all of their medical expenses and it doesn’t matter how they were injured.  This is not always the case, and your car insurance does have options that will take care of you if you are in an accident and need care.  If your car insurance is insufficient, you could be stuck without enough insurance to pay for your injuries at all.

Car Insurance and Medical Expenses

Here are some of the car insurance coverages that help with injuries after a car accident:

1. Personal injury protection (PIP) coverage generally has a fairly low limit. It does pay for injuries occurring after an auto accident, but usually serves to augment the medical insurance policy that you have. It can basically help with your deductible and will only pay for a full doctor’s visit if it is substantially low.

2. Bodily injury liability pays for injuries that a person causes to another person. If you’re at fault for an accident, your insurance pays for the other person’s damages and injuries; the same is true in reverse whenever somebody else hits you. This coverage has no deductible and pays up to a limit. Once the limit is exhausted, no more funds will be sent out.

3. Medical payments coverage is a first-party insurance like PIP, but it has higher limits and covers more expenses. Most start paying out up to $5,000 for each person in the car who have sustained an injury.  This coverage is for each accident, not annually.

4. Uninsured and under-insured motorist coverages serve to replace bodily injury liability whenever a person is involved in an accident with someone who has no insurance or whose insurance is not high enough to cover the costs of the accident.

Will my Health Insurance cover car accident injuries?

Your medical insurance will pay for injuries only if no other insurance will cover the loss. This is true of all types of injuries. For example, a medical insurance company may refuse to treat an injury that happens while you’re at work until the company is sure you won’t be receiving any worker’s compensation. The same is true of car accidents.

If you do not have car insurance or your insurance has no medical coverages, your health insurance company will most likely cover the cost of your injuries if you were the only person involved in the accident. If another person was involved in the collision, the health insurance company will wait to see if the other party is at fault and their insurance will cover your injuries.  Because most health insurance companies will not move forward with paying a claim until all other claims have been denied, it can take quite a while to have your medical expenses covered. 

Oh, the happy wonders of insurance….


When Is It Good To Get An Attorney After A Car Accident?

Not only is car repair expensive but so are medical claims that have been accumulated after an auto accident.  The more insurance companies involved, the more complicated the process becomes.  If you’re in a situation where multiple car insurance companies are involved or your injuries will only be covered by a third party (the other person’s insurance); working with your health insurance to cover very expensive medical care can get confusing.  You may need or want to get the assistance of an attorney.  Often times third party insurance companies tell you that car repair and medical expenses will be paid by them easily, but in the end, they won’t pay medical professionals and those professionals then expect payment from you.  If you are not insured by them, they have no urgency or responsibility to pay for your medical or car repairs.  

When you are injured after an accident, the last thing you want to do is negotiate with an insurance that doesn’t insure you…they insure the person who hit you.  Better to focus on getting better and let someone else deal with the stress of payments.

An attorney will be able to help negotiate a higher settlement for you and explain the process in terms that you will understand.  A good attorney will be invaluable in helping you settle a claim. Be aware, however, that once you hire an attorney, your ability to communicate with the insurance companies will be limited and in most cases, the attorney automatically gets 1/3 of all settlement funds.

We work with attorneys on a lien and can help you get the care you need after an accident.  Call our Redwood City Chiropractic office today, this will allow you to get back on the road to health.

Do You Have To Use The Auto Body Shop Your Insurance Company Recommends?

Most insurance companies have repair contracts with body shops in your area.  If you use whomever they suggest, it benefits the insurance company because of negotiated lower labor and repair rates.  Insurance companies will also require their shop to provide a lifetime warranty but there are a lot of shops that do that already.  You just have to ask.

Insurance company claims representatives are given set goals that they need to achieve as far as costs.. They would like to see around 40% of their claims go to the repair shops they have suggested to their policy holders.  If you have chosen your own repair shop, claims representatives will frequently try to sway you away from using the body shop and tell you that the shop is not on the warranty list and it could effect payment of your claim.  They may explain that it will take up to a week before an adjuster will be available to write an estimate on your car which no one is really fond of.  They also may say that there will be no warranty if you don’t use someone on their list.

In my opinion that is really not cool.  Any great body repair shops will be confident in their work and offer a lifetime warranty no matter who is paying the bill. Shops are systematically interested in handling your claim and the repairs efficiently. Also, most body shops know how insurance company’s claims are processed, making it easy to complete the estimate process and repairs quickly.

So, the answer is No. You don’t have to use the body shop that AAA, Geiko, Farmers, State Farm etc. has recommended. The choice is yours by law, in the majority of cases. Will you still get top notch repairs?

Overall, whether it’s the insurance company’s recommended shop or your shop of choice, it is important that you choose a repair shop that you feel confident in. Ask friends, family and co-workers for recommendations. You can also research body shop reviews online through websites like Angie’s List.

Here are some questions to think about:

  • Does the shop have a lifetime warranty?
  • Do they have experience working on your type of car?
  • How long have they been in business?
  • Have they worked with your insurance company before?
  • What is the likelihood that the estimate will go up once the repairs have started?

Just so you know, the shop you choose doesn’t have to be on your insurance company’s direct repair list.  A reputable body shop will work with any insurance company to restore your vehicle back in tip top shape.

References: http://www.angieslist.com/articles/do-you-have-use-body-shop-insurance-company-recommends.htm

How Do Wellness Programs Help Companies Save On Health Costs?

In a story published to a March 11, 2002 issue of the American Medical News. This story reports on several studies and programs where corporate wellness programs are having a positive effect on reducing health care costs on their employees. “There’s a growing body of data indicating that corporate wellness programs lower medical costs for employees”, said Ron Z. Goetzel, PhD, vice president of consulting and applied research for the Medstat Group, a health care research firm in Ann Arbor, Mich.

A survey done by Medstat, published in the January 2002 issue of the Journal of Occupational Medicine, concluded that medical claims costs for Johnson & Johnson Inc. employees dropped an average of $225 per year after the company started its wellness program in 1995. Additionally, Goetzel reported that a literature review of corporate wellness studies published in the May/June 2001 issue of the American Journal of Health Promotion concluded that medical costs dropped for employees in the wellness program for 28 out of 32 of the corporate wellness programs reviewed.

The report claims that about 90% of Johnson & Johnson employees participate in the corporate wellness program. Their program consists of free health risk assessments and physicals. Additionally employees can then join free weight management, smoking cessation or nutrition classes and can use on-site fitness centers. John McKeegan, a Johnson & Johnson spokesman stated that the savings in reduced medical claims total about $5 million a year. When you factor in administrative savings from combining various health services into one program, McKeegan estimates the savings come to about $8.5 million a year.

The Wellness Councils of America, a coalition representing 3,000 corporate wellness programs, estimated that presently 80% to 90% of large U.S. corporations offer some sort of wellness program.

Our Redwood City Chiropractic office is in the heart of the high tech area and see many patients who work in Silicon Valley.  One problem they have is postural issues stemming from working on laptops, smart phones and sitting at a desk for long periods of time.  We help these individuals with alignment, proper ergonomics and postural exercises.  If you are in the Redwood City area, give us a call.  Even if you don’t have symptoms, getting checked to see if lifestyle changes need to be made preventing any issues that may be on the horizon.

References: http://www.chiropracticresearch.org/