Allowed Amount: Also referred to as approved charge, allowable charge. This is the dollar amount typically considered payment-in-full by your insurance company and its network providers. The allowed amount is a discounted rate rather than the actual charge. For example, you visited a doctor who is an in-network provider of your insurance, and the total charge for the visit was $100. Your doctor is required to accept $80 as payment in full for the visit—this is the allowed amount. Your insurance will pay your doctor $80, minus any copay or deductible that you may ow. The remaining $20 is considered “write-off”, and you cannot be billed for it. If your doctor is not within your insurance network (an out-of-network provider), you may be responsible for the full charge of $100.
Co-payment (Copay): A dollar amount that your insurance may require you to pay for an office visit.
Coinsurance: The amount that your insurance may require you to pay for covered medical services AFTER you have satisfied co-payment and/or deductible. It is typically expressed as a percentage (%) of the allowable charge for a covered medical services. If the coinsurance is 80/20, for example, your insurance covers 80% of the allowable charge. Then you are required to pay the remaining 20% as coinsurance.
Deductible: A dollar amount that your insurance may require you to pay out-of-pocket each year BEFORE your insurance plan begins to make payments for claims. Not all plans require a deductible. A deductible resets on the renewal date, which is typically January 1st.
Out-of-network Providers: Healthcare providers who are not contracted with the health insurance plan. Typically, if you visit a provider within your insurance’s network (in-network provider), the dollar amount you will be responsible for the medical service will be less than if you go to an out-of-network provider.
Out-of-Pocket Limit (OOP Limit, Stop-Loss or Coinsurance Limit): The most you have to pay for covered medical services in a plan year. After you spend this amount on a deductible, copay and coinsurance, your insurance will pay 100% of the costs of covered benefits. Out-of-pocket maximum resets with the plan year, like a deductible.
Medicare:
The only chiropractic service covered by Medicare Part B is manipulation of the spine if medically necessary to correct a subluxation. You must pay your deductible for Part B services before Medicare begins to pay its share. After you meet the annual Part B deductible, you pay 20 percent coinsurance of Medicare-approved amount.
Medigap supplemental insurance (AARP, Aetna, Blue Cross, Humana, etc.) will fill some of the gaps in medical expenses that Medicare doesn’t pay.
Medicare and Medigap do NOT cover all the costs for any other services or tests ordered by a chiropractor. You need to pay the full cost of electrical stimulation, ultrasound, massage therapy, exercise, an x-ray and a physical exam.
If you are enrolled in a Medicare Advantage Plan (Part C), your plan may cover broader chiropractic treatment than Part B and Medigap do. Please check with your plan directly.
Please Contact Us for more details.