Deductible?

[chemteacher03]

I have been going to a chiropractor for the past month as they cover 100%. I asked the chiro up front, what will be my out of pocket expense...he said none. We decided to do orthotics since I have flat feet. I asked him what the oop expense would be...he said that insurance should cover a vast majority - 80-90%. Well, I received some of the bills in the mail now from insurance. All of the treatments are covered 100%. Unfortunately I now have a bill for $480.00 for my deductible (350), co-insurance (110), and copay (20). All of this is due to the orthotics. Now, the chiro's office told me that if I don't want the orthotics, I don't have to get them...my question is since the deductible is based on the orthotics, will I have to pay the deductible then? Another teacher where I work has had only the treatments and has to pay nothing (no deductible, no nothing). I wonder if I will be able to go into the chiro tomorrow, show him the bill, then have him not get the orthotics... I'm a little peeved right now honestly. Also, I got my wife to start with me and she has a different insurance company where her dedeuctible is 1500. We were upfront about us not wanting to have to pay anything oop for her either. He said we would work it out by billing the insurance company for the orthotics to get the deductible met...if that's the case, won't she have to pay 1500 oop? What the hell? It would be cheaper to just not go as often... So, tomorrow, either he can explain to me how I won't have to pay $480 or else that will be it...I'm done there...and so will my wife...we'll have to get everything straightened out with both her and my insurance as well...especially since I have not received the orthotics yet...

Advice?

 

[CarolA]

Do you have a clue what your policy pays????
Advice below.....

1. YOU need to read YOUR policy. Any advice you get here or from your Chiro is NOT reliable. The advice I am giving is based on general knowledge. but may not apply. (Chances of you having a policy that pays 100% of unlimted treatments in this day and age are slim and none.... union jobs in selected industry would be the slim chance)

2. You or your wife need to READ her policy.

3. Do you have the orthopedics, if not the amount you owe is probably for the treatments. If your doctor billed for services not provided that's a WHOLE NEW ISSUE (and NOT good!!!)

3. If you can't figure it out CALL your HR or the insruance company NOT the chiro. (Who apparently sees you two as an income source, just from what you are telling me here, I have some real questions about his billing practiices....)

4. If your wife has an OOP that has to be paid first then NO matter what you owe the 1500.

 

[Colinsmom]

Also, I got my wife to start with me and she has a different insurance company where her dedeuctible is 1500. We were upfront about us not wanting to have to pay anything oop for her either. He said we would work it out by billing the insurance company for the orthotics to get the deductible met

Huh? The orthotics have nothing to do with your wife's insurance - they are for you. You don't want to pay oop for her, but her deductible is $1500. So you are asking the chiro to treat her for free, or commit some kind of insurance fraud (by billing her visits as yours? I don't know). Her deductible is $1500, so you must pay the first $1500 of her expenses, period, whether they are for chiro adjustments or orthotics for her.

Your chiro doesn't know your insurance benefits - that is your job. None of us can tell you what you might have to pay if you cancel the orthotics since it is completely dependent on the terms of your plan.

 

[chemteacher03]

My insurance does pay 100% for chiro treatment...just not the orthotics. I asked my insurance company if I were to refuse the orthotics, would I have to use my deductible...their answer was no...so that's what I will be doing when I see the chiro today. Also, my wife has her own insurance and she is also a patient of the chiro...she is just in the same situation I am in as far as meeting the deductible for her own orthotics. I'll advise her to call her insurance and also the chiro to cancel the orthotics so her deductible wil not be used either. Her plan does not cover chiro 100% whereas mine does. I'll just have to pay for the chiro for her 2 visits she has had.

 

[aclov]

My advice:

Read your summary plan description for your insurance

Contact your insurance company so they can quote you benefits

See your HR/Benefits Dept.

 

[CarolA]

Are you telling me your chirio billed your insurance for orthotics you don't have????

Did you mention this to your insurance company?

(And the industry wonders WHY they have a bad reputation???? Billing for services not provided is a HUGE red flag!)

 

[tinan]

Ok, as others have said you should know what your policy covers or doesn't cover and if you are still unsure contact either HR department or the insurance company. Secondly, the insurance company should have sent you either a letter of what their intentions are of paying or your explanation of benefits. Since they are orthon. your chiro. probably needed to get pre-certification to see if they would even cover them and at what level. When your chiro. said that they would cover the majority, he/she was partially right. Yes, your insurance company does pay a majority AFTER your deductible is met and your chiro. doesn't know where you stand with your deductible. It sounds as though your total year deductible is $350. If you were to go ahead and get the ortho. then you have met your deductible for the year just with those alone. If you would happen to need anything else major this year, you would probably only have your co-insurance amount on that and maybe a co-pay. If you don't want the ortho. and this is only a letter of pre-cert. then you should be ok with cancelling the ortho. I'm not sure how quickly your chiro. moved on getting those made or if he was waiting to hear from the ins. Just give him a call and talk to him about it.

On another note, I would look into adding your wife on to your insurance. It sounds as though you have the better of the two insurances and so long as it is not majorly cost prohibitive, I would look at this.

 

[chemteacher03]

I'm going in today at 3 to see them about this. They have ordered the orthos, but they said they should be able to cancel them. So, the insurance company is correct in that orthos were ordered, but I am deciding to refuse them. If I were to add my wife to my policy we would see a huge increase. Also, her work pays for her insurance.

I really hope this can be worked out. I don't foresee anything else healthwise this year for me to warrant the need to use the deductible. If they force me to do it, so be it..lesson learned...talk to insurance before anything. I simply don't want to have to pay the 480 because we are going to Disney in about a month and we are still trying to save for our food and souveniers while we are there.

Would orthotics help me? Since I have flat feet, yes. I think I will try something else first (just some regular insoles) and then see if I notice a difference. Also, I don't notice a big difference when I go to the chiro to be honest. I still have the same aches and pains 6 weeks ago that I do now still.

I'm just going to stop going to the chiro and also cancel the orthos. It's clear across town to get there anyways and also when August starts, I won't have time to go in there again.

 

[chemteacher03]

Woo! I just got back from the chiro. Basically, he is waiving the amount I would have had to pay for the deductible...same as my wife. So rather than me having to pay 480 (deductible, copay, and co-insurance) for the orthotics, I'm paying nothing as my insurance covered quite a bit of them already. God I hope that's it now from that. I also requested to get this in writing that I would not need to pay anything either out of pocket or using my deductible for the orthotics. God! There is a reason why I did not become an insurance agent...too damn confusing...I'll stick to chemistry.

 

[IMALOVNDISNEY]

chemteacher03 I was just about to answer on behalf of a Chiro office. But, I see all has turned out well for you. Your Chiro office did the same as what we would have done here in our office. Or office w/o quite abit of things in order to make things affordable for the patient. Unfortunetly the insuance co's make it almost unaffordable for the members to have proper treatment.

Most people don't realize that alot of policys have seperate deductibles for different things. Your orthodics are considered DME(durable medical equipment). Most policys don't cover any of these. (so in a sense you have a better plan than most).

Ultimately it is the patients resposibilty to know your policy....I have made it our office policy to know any and all benifits that may pertain to our office. and you are quoted your benifits on your first visit.

NOT ALL CHIRO'S HAVE A BAD REPUTATION. THERE ARE MORE GOOD THAN BAD.

 

[CarolA]

Just a hint for the "chiro" defender.

Waiving deductibles/co insurances etc is not good.

Insurance companies and CMS see that as "discounting" And they believe that if you are willing to discount, they want thier share.

These payments can be waived for medical hardship etc, but you better have your ducks in a row.

In my real life I have spent a LOT of time cleaning up messes caused by this practice by both MDs and hospitals.....

 

[bumbershoot]

Woo! I just got back from the chiro. Basically, he is waiving the amount I would have had to pay for the deductible...same as my wife. So rather than me having to pay 480 (deductible, copay, and co-insurance) for the orthotics, I'm paying nothing as my insurance covered quite a bit of them already. God I hope that's it now from that. I also requested to get this in writing that I would not need to pay anything either out of pocket or using my deductible for the orthotics. God! There is a reason why I did not become an insurance agent...too damn confusing...I'll stick to chemistry.

OK...I am a chiropractor, and what that DC has just done is fraud.

Don't get me wrong, I've been part of that as a teenage patient, where the DC waived the deductible and copays from my mom...we were so happy about it.

But the thing is, she didn't do it for CASH paying patients. And that's the difference. At least here in WA, a provider can give a discount to anyone for anything. But it canNOT be done solely for insurance purposes, and if it is, then it's fraud. This chiro is playing dangerous games with his practice.


You have INCREDIBLY GOOD INSURANCE. I hope you realize that. To have the visits covered 100% with no deductible? It's astonishingly good insurance. Too bad your wife isn't on your insurance, that would be such a savings for you.

I never really got into the whole orthotic thing, no one could prove to me that they really helped beyond what chiro could do for you.

Have you noticed ANY changes? Posture, feeling better in ways you don't expect, having more energy (when I found the kind of chiropractic I practiced, I thought it was silly until one day after leaving, I went to the gym and did 2 hour-long step aerobics classes in a row and wanted to do a THIRD, but it was the same teacher as the first, so I just went and did weights and treadmill for another hour...after that I was convinced my body had changed), anything like that? Sometimes people experience huge changes fast, sometimes it's more subtle... And sometimes when you're seeing the wrong person or having the wrong technique used on you, you might not notice anything...



To me, if there's something I NEED or want, health-wise, and it will cause part of my deductible to be used for the year, that's a GOOD thing. That way, should something drastic happen later in the year, that's less out of pocket for me to pay.

 

[chemteacher03]

Will I get into trouble for this? I sure hope not. Normally I would have paid the deductible, co-insurance, and copay, but we are going to Disney oddly enough in about a month, so I really was unable to pay for it right now. If he asks for me to pay for it later, then I have no problem doing it. I don't want him or me to get into trouble...hopefully not...