If you rewind the calendar back to 8 or 9 years ago, health insurance companies, with the exception of Medicare, DID cover a full range of therapy options in the Chiropractic office.  Unfortunately, present day, most only cover the quick, in-and-out adjustment only.  They will tell you they cover more, but in reality, most have capped reimbursement rates at $55 (most United Healthcare policies), $60 (BCBS of TN), Aetna (typically $70 or less). Cigna was one of the first companies to begin limiting Chiropractic coverage.  We can't speak to their current reimbursement rates since we are not in network.  We regularly have patients who call asking what their out of pocket cost will be so we decided to make it easier by being as transparent as possible, even including exactly what you will be responsible for during the scheduling process.  A lucky few - postal and federal employees with BCBS coverage, United Healthcare of the River Valley policies, and a few select others, continue to enjoy more robust coverage which typically covers a more complete visit.

Patients have been caught in the middle with this issue, not realizing the present day limitations of their coverage.  Providers have been forced to change their way of providing care to primarily the adjustment only.  We are not doing that!  We don't feel we can provide adequate care by providing adjustment only visits.  We only provide longer duration visits, either 30 minutes or a full hour therapy visit.  You simply need to decide what you are looking for.  The majority of people are content with and actually prefer the quick, adjustment only visit.  For those who want a little more from their visit, we are here to serve you with a longer visit time and more thorough care.  It will cost a little more, so you have to decide which type of care is best for you.

Example 1:  Standard United Healthcare coverage

Policy allows for $55 maximum reimbursement to provider no matter what services are performed minus your copay.  Your copay may be up to $50, in which case, United Healthcare would only reimburse the provider a grand total of $5!  In addition, pre-notification requirements are still in effect, which means your provider must log in to a United Healthcare website, provide them information about your visit, and submit for review which can take up to 15 minutes!

Let's say your copay is $25.  Here are two scenarios for your out of pocket costs.

Full one hour visit - Total charge, $195
United Healthcare reimburses the provider $30.  You will owe $195 minus $30 = $165

30 minute visit - Total charge $99
United Healthcare reimburses provider $30.  You will owe $99 minus $30 = $69

Example 2:  BCBS Shield of Tennessee S Network coverage

Policy allows for $60 maximum reimbursement to provider no matter what services are performed minus your copay.  

Let's say your copay is $25.  Here are two scenarios for your out of pocket costs.

Full one hour visit - Total charge, $195
BCBSTN reimburses the provider $35.  You will owe $195 minus $35 = $160

30 minute visit - Total charge $99
BCBSTN reimburses provider $35.  You will owe $99 minus $35 = $64

Example 3:  Aetna

Aetna is slightly different in that they still provide greater reimbursement for an initial visit which takes more time with the exam and consultation.  After you have met your deductible, they may pay slightly over $100 for the initial visit.  Following the initial visit, from our experience, their reimbursement is around $70 for the one hour visit and around $50 for the 30 minute visit depending on services performed. 

Let's say your copay is $25.  Here are two scenarios for your out of pocket costs.

First one hour visit - Total charge, $195
Aetna reimburses the provider $105 minus your $25 copay = $80.  You will owe $195 minus $80 = $115

Additional one hour visits - Total charge: $195
Aetna reimburses the provider $70 minus your $25 copay = $45.  You will owe $195 minus $45 = $150

30 minute visit - Total charge $99
Aetna reimburses provider $35.  You will owe $99 minus $35 = $64

Example 4:  Medicare

Medicare covers the Chiropractic adjustment ONLY.  Since we provide a full therapy visit, Medicare does not provide coverage.

One hour visits - Total charge: $195 which Medicare does not cover

30 minute visit - Total charge $99 which Medicare does not cover

If you have Medicare coverage, you can still receive care.  Your out of pocket costs will be $195 for the full hour visit and $99 for the 30 minute visit.