So often we have patients asking, "Does my insurance cover chiropractic care?" During our consultation, our patients usually are shocked to find out exactly what kind of coverage they are paying for. Buying insurance should be just like buying a home or a car--you should know exactly what you are paying for.
When choosing the correct insurance for your needs, you should always find the coverage that best suits your health care concerns. In other words, if you primarily use your chiropractor, dentist, family practitioner, and OB-GYN, your insurance should have the appropriate coverage. Always ask your insurance sales representative what coverage you have and what you are expected to pay out of pocket.
What is the difference between an HMO (Health Maintenance Organization) an a PPO (Preferred Provider Organization)? These terms are important in choosing a health care carrier and should be understood. An HMO is a plan that restricts your choice of providers. Usually, when sold this type of plan, you are told that it will be your most cost-effective premium. This, however, is not necessarily true. A PPO lets you leave your network so you can see the provider of your choice. We highly recommend this type of plan.
An HMO means that you will only be able to choose your provider from your network manual. If you want to see a particular specialist who is not in this book, your responsibility will be 100% of that bill. Your advantage with this type of plan will be if your doctors are providers within the network. Your responsibility will be a minimal copayment of approximately $10 per visit. As for a PPO, this plan will leave you with the most freedom. Your premium should be within $10 to $20 of that of an HMO. With a PPO plan, you will also have a network manual from which to choose your provider. However, you will have the freedom to go outside your network and see the doctor of your choice. Be warned--if you choose to see an out-of-network provider, you will be responsible for 20% to 40% of your total bill and a deductible. This is the insurance companies' way of punishing you for leaving the network.
Generally, we will see deductibles ranging from $200 all the way up to $4000. Most insurance plans will have a $500 out-of-network responsibility. The best way to find this out will be through your sales representative.
Our patients quite often ask if we are providers in their network. Unfortunately, getting accepted in Atlanta is very difficult due to the high volume of chiropractors in the city. We are, however, a provider for PHCS. PHCS is a PPO and is one of Atlanta's largest insurance organizations. To find out if you are covered under PHCS, look at your insurance care and you will see the symbol representing this type of coverage. We are not a provider for any HMO in Georgia through 1999. If we are accepted to any other carriers we will let you know through a direct mailer and our newsletter.
If you ever have any questions regarding your insurance or how to get insurance to fit you needs, please feel free to call our office.
