Medicare Policies 

The purpose of this information is to enlighten our patients in the rules and regulations of Medicare as they apply to chiropractic and our individual practice.

 The Medicare insurance program is a Federal program, which included chiropractic in 1973.  Its purpose is to provide health care for the elderly and/or disabled at a lower cost.

Medicare Does Cover Chiropractic Care, But With Limitations

Coverage of services provided by a chiropractor is limited to vertebral adjustment of the spine to correct vertebral subluxations demonstrated by X-ray and/or other documentation to exist.  Medicare will only pay for the adjustment.  Medicare will not pay for any other service provided by a chiropractor.

Even though Medicare does pay for vertebral adjustment to the spine, it greatly limits the amount of care a patient may receive.  At any point they may deem the amount of care “not reasonable and necessary” and deny payment.

Medicare requires us to inform patients of what may or may not be covered in writing at the time any service is rendered.  This is hard to do since it seems to change on an almost daily basis and depends largely on whom we ask at the Medicare office.

The following is the way we understand their policies regarding chiropractic at the present time.

Services Usually Covered By Medicare

1.    Initial care - Medicare will usually approve from 12 to 20 visits over the first ninety days of initial care depending on the nature and severity of the problem.

2.   Acute Care - after your initial care is completed, Medicare only approves care that “they” consider to be acute.  Acute care means care for a new injury or condition.  This care must be substantiated by a date of the injury or exacerbation, exactly what happened and the specific symptoms that result from the injury.  Acute care usually is expected to last no more than three to five weeks.

3.      Recurrence - A recurrence is a return of symptoms of a previous condition that has been quiescent for a period of time. (Usually several months)

Your Responsibility For These Covered Visits

It is your responsibility to report to us any accidents, falls, blows, jars, strains etc. that makes your condition worse or causes new problems.

We ask that you tell any one of our assistants about this before you see the doctor on each visit.  They will be happy to help you with any necessary paper work.  Reporting everything to us will greatly increase the chances of your visit being approved by Medicare.  Please do not make up anything but tell us everything.

Spine Care Policies And Fees For Covered Services

Fees for Medicare visits are $40.00.  Medicare pays 80% of this fee for the visits they approve after you have met your deductible for the year.  This amounts to $32.00 per visit.  Your co-payment is $8.00 and is payable at the time of each visit.  We do not take assignment on your co-pay.  In most cases your co-pay insurance will reimburse you your $8.00 for visits Medicare approves.  Please keep in mind that co-pay insurance does not pay for visits Medicare does not approve. 

Your condition may require more care than allowed by Medicare.  If you have an injury or exacerbation we can apply for additional care by submitting a “necessity statement” on your behalf.  Your case will be sent for review.  We cannot guarantee or predict what the review board will decide in your case.

Medicare requires that we inform you of what may or may not be covered on each visit.  For this reason you are required to sign a special form on each visit.  The purpose of this form is to explain to you services that may not be covered. 

Any visits denied by Medicare become the financial responsibility of the patient. 

Services Not Covered By Medicare

1.    X-rays - Medicare does not pay for x-rays.

2.   Maintenance Care - Any ongoing care such as once or twice per month is now considered by Medicare to be maintenance care.  It is listed by them as an “Excluded Service” and is not a Medicare benefit.

Spine Care Policies And Fees For Non-Covered Services

We feel that every patient benefits from some amount of ongoing care.   Even when much of the original problem has improved there remain weaknesses in the spine that often require some amount of ongoing care.

Maintenance Care Program For Seniors

We offer a special “maintenance care program for seniors”

This program offers ongoing chiropractic care to our patients at very affordable fees.

Again, Medicare does not cover this "ongoing" or "maintenance" care.  Its purpose is to promote better function, enhance the quality of life, to stabilize a chronic condition or to prevent deterioration.

If you elect to join our “Maintenance Care Program For Seniors” and happen to have an accident or injury requiring acute care, you may switch back to our regular  “Medicare Program” until the acute problem is resolved.

Requirements   

1.     Must sign “Request For Maintenance Care Form” each visit.

2.   Must make one visit per month or more.

3.   Must pay for each visit when made (May use Master Card or VISA)

Please Remember No Insurance Forms Or Statements Will Be Filled Out For These Visits Now Or In The Future.

Special Fees For Non-Covered Services

1.     X-Rays - It is our policy to share the cost of all necessary x-rays with our Medicare patients.  The patient pays one half the normal cost of any x-rays.

2.      Maintenance Care Visits For Seniors - fees for these visits are $15.00 each payable at time visit is made.

 Summary 

1.  Chiropractic And Medicare - Medicare limits your Chiropractic care to “Initial Care” and/or      “Acute Care”. Acute Care is care of a new injury or condition or a recurrence of a previous        condition that has been quiescent for a period of time. Any acute care must be documented by       the date of the injury or exacerbation, what happened to cause the problem and the symptoms        that result.

2.  Your Responsibility - It is your responsibility to tell us before each visit if you have had any accidents, injuries, falls, strains etc.

3.  Our Responsibility - It is our responsibility to inform you on each visit whether or not we feel Medicare will approve your care for that visit.

4.   Your Choice - If we inform you that we feel Medicare may not approve your care on any  particular visit you may choose:

      A.  Have us file your visit with Medicare anyway.  If this is your choice, we will be happy to file your claim.  If your deductible has been met for the year, you will be asked to pay only your co-pay at the time of the visit. If Medicare refuses payment, you will be billed for the entire amount.

      B.   Be seen under our special “maintenance care program for seniors”.  If you choose this program, you will be asked to sign a request form that states among other things that you do not want us to file this visit with Medicare. 

Note:  It has always been our policy to see all patients regardless of their financial ability to pay.  If any of our fees place a hardship on you, please feel free to discuss it with our business office.  They will be happy to work out a plan for you.