Please Note: A 3.95% surcharge is added to all Credit Card payments, except HSA and FSA, both of which are acceptable payments.
Insurance Coverage for Chiropractic Care
I accept most PPO Insurance, such as, Aetna*,Anthem, Cigna (not My.Cigna) Blue Cross/ Blue Shield, Blue Shield of CA, Federal Employees, Labor Union Insurance and Kaiser PPO and POS via MultiPlan PHCS only (NOT Kaiser HMO!). I also "in network” for Optum, Veba, and many UMR and United Health Care policies. However, you must verify if I am in or out of network (See Options 1 and 2 below). "Out of network" often still pay but the deductible and co-pay will be higher. I do not accept any other HMO insurances such as Kaiser, Scan, Landmark,Humana, Morena.
Some Aetna and Anthem uses American Specialty Health (ASH) for chiropractic which I do not accept.
I do NOT accept Medical, Medicaid, Community Health, or Covered California policies.
Please note that visits for Alternative Holistic Nutritional Care and Services are NOT insurance reimbursable, cash fees listed further below will apply.
For Medicare coverage scroll further down to the Medicare section below.
IF you wish to use your Medical Insurance for chiropractic care, you have two options:
Your first option is to simply pay cash fees listed further below by scrolling down. I will then bill your insurance and forward any insurance checks to you.
Your second option is to confirm your insurance coverage at my clinic by calling Member Services on the back of your card.
- Ask if I am in network or out of network for chiropractic care. (If UHC or UMR, ask if prior authorization or referral is needed. Note: I do not accept insurances that need medical referral or prior authorization)
- For Aetna and Anthem ask if American Specialty Health (ASH) is used to process chiropractic claims. I do NOT accept insurnce that goes thru ASH.
- You should then confirm what your deductible is, and if it has been met.*
- Confirm what your per visit co-pay is once your deductible has been met.*
- Then inquire as to any number of visits limitations.
- Those of you with insurance who have not yet meet any remaining deductible will pay on per visit based on the Cash Fee Schedule (scroll down further below) until any deductible* has been proven to be met, after which agreed upon co-pays*will be paid per visit.
- Please be aware that you are responsible for your bill, not your insurance company. A credit card will be kept on hand to cover any subsequent insurance non-payments, but not to exceed the cash visit fees as listed further below (scroll down).
- Also, some insurances send checks to you, not to me. In that case if you do not send that check to me promptly, I will bill your credit card.
- Co pays and deductibles payments may be by cash, check or credit/debit cards (4% surcharge for credit cards)
- I accept both HSA/ FSA. The above 4% surcharge does NOT apply. fee.
- I will submit all insurance forms for you at no fee.
Definitions*:
A deductible is a dollar amount of how much you must spend on covered medical expenses before your insurance will begin to pay part or all of your expenses.
Once a deductible has been met, a co-pay is then usually required, either a dollar amount or a percentage of the per visit cost,
Nutritional supplements, pain relieving salves, ice/heat packs and orthopedic supports, IF recommended, are paid for at the time of purchase.
Lab testing is not routinely ordered but it is available when indicated or desired on a cash fee per test basis.
I do not have X-Ray facilities. X-rays, which on occasion are needed, are usually referred to a walk in Valley Radiology site nearest you. They accept most insurance.
Personal Injury and Workers Compensation Cases
I do not accept PI Liens for New Patients. However, I will consider PI liens for current and former patients on a case-by-case basis. Call and ask. A credit card will be kept on file to cover any non-payments, but not to exceed the cash visit fee schedule.
I will consider Med Pay car insurance for personal injury on a case-by-case basis. A credit card will be kept on file to cover any non-payments, but not to exceed the cash visit fee schedule. Also, some insurances send checks to you, not to me. In that case if you do not send that check to me promptly, I will bill your credit card.
I do not accept workers compensation cases unless referred by One Call Physical Therapy. The only financial responsibility for patients referred by One Call is the $20 missed appointment fee without a 24 hour notice. A credit card will be kept on file to cover this fee if incurred.
Medicare
I am a Preferred Medicare Provider accepting those with both Medicare Part A and B and those with secondary insurance payers such Plans G, N and F.
I am also in network for UHC Medicare (such as UHC AARP Advantage and UMR). However, some. UHC, UMR Medicare plans require a medical referral. You can call member services phone # on the back of your insurance card or consult your annual Medicare Handbook to see if referral is required. I do not accept such plans. Also make sure to inquire as to any number of visit limitations.
I do not accept any other Medicare HMO’s (Scan, Kaiser, ASH etc.).
Important Notes:
Medicare plans only pay chiropractors for adjustments of the spine. They do not pay for initials exams ($95) or re-exams ($75) for new pains or injuries, or marked exacerbations of symptoms, or if not seen for a long period of time.
Medicare also does not reimburse chiropractors for extremity adjustments, physical therapy, acutherapy (acupuncture without needles), dietary and supplement analysis, rehab exercise instruction, activities of daily living training. As such, all Medicare patients will have a co-pay / surcharge of $20 for routine office visits.
A credit card will be kept on file to cover any non-payments, but not to exceed the cash visit fee schedule (below).
Nutritional supplements, pain relieving salves, ice/heat packs and orthopedic supports, IF recommended, are paid for at the time of purchase.
Lab testing is not routinely ordered but it is available when indicated or desired on a cash fee per test basis.
I do not have X-Ray facilities. X-rays, which on occasion are needed, are usually referred to a walk in Valley Radiology site nearest you. They accept most Medicare insurance.
Cash Fee Schedule:
Those without insurance coverage for chiropractic, or who have not yet met their deductible, are paid for on a cash basis as presented below. (
Cash fees are the same whether for chiropractic or nutritional holistic care is desired. Payments may be by cash, check or credit/debit cards.
New Patient Exams are $95: This fee usually covers all care, instructions and advice given, including adjustments and therapy on the initial visit. Supplementation and orthopedic supports IF recommended are paid for at the time of purchase. Lab testing is not routinely ordered but it is available when indicated or desired on a cash fee per test basis. I do not have X-Ray facilities. X-rays, which on occasion are needed, are usually referred to a Valley Radiology site nearest you.
Established Patient Re-exams are $75. Re-exams are needed for new injuries, marked exacerbations or patients who have not been seen in a long time and re-evaluation is needed. Treatment is included.
Routine 0ffice Visits are $55. This a usually a "per diem" fee meaning all services are included.
Supplementation and orthopedic supports IF recommended are paid for at the time of purchase. Lab testing is not routinely ordered but it is available when indicated or desired on a cash fee per test basis. I do not have X-Ray facilities. X-rays, which on occasion are needed, are usually referred to a Valley Radiology site nearest you.
Missed Appointment fee $20. If you are unable to keep an appointment my policy is that you kindly provide me with at least 24 hour notice to avoid our $20 fee.