Frequently Asked Questions by Patients

What are my chiropractic benefits? This is a great question. It should be easy to answer, but it is not. Every benefit plan is different. Some have chiropractic benefits, some do not. Some plans have a limit on the number of visits, some limit the amount paid or allowed per visit, and some limit both.

To get an accurate answer to this question, you should do two things:

1. Consult your Plan Summary Description or Benefit Plan Booklet. Read it carefully, paying close attention to what is not covered under the Plan Exclusions. In many cases, these booklets are just summaries. If they are complete they are often difficult to understand, even if you work within the insurance industry.
   
   
2. Call the customer service or insurance verification phone number located on your insurance identification card. Do not rely on a co-worker or supervisor for answers on this issue. They may be wrong. Ask the company administering the benefits. Be sure to tell them your problem and, if an accidental injury, how it happened. Benefits often vary depending on the reason for the treatment.

You want to clarify your financial responsibility. Ask about deductibles, co-pays, in-network benefits, and plan limitations. Obtaining this information before incurring treatment will help you avoid frustration later.

When you show up for treatment or schedule an appointment, the chiropractor’s office will usually verify this information also. You can ask them questions to make sure you have the same answers.

Do I have any financial obligation? Yes, most of the time. It is very rare for a benefit plan to pay for everything. The network chiropractor provider is agreeing to accept the network fee schedule, but you are still responsible for deductibles, co-pays, claims that exceed the plan limits and services that are specifically excluded by your plan. Also, if you provide incorrect insurance information to the provider, the entire claim may be your responsibility.

It is best to determine your financial obligation up front. The chiropractor’s office assistant will be happy to help you with this question.

How do I select a chiropractor? There are many ways to do this. Our job at Integrated-ActivHealthCare is to provide a network of qualified chiropractic providers. Although we cannot guarantee the specific outcome of your treatment (no one can), we do require that every provider in our network meet stringent credentialing guidelines.

Having said that let me give you a more practical answer. Our website includes a Provider Locator function. You can search by zip code to find a provider near your home or work.

What if my chiropractor is not a member of Integrated-ActivHealthCare? Although we offer one of the largest networks in the state, we are not able to accept every chiropractor. If your chiropractor is not a member of Integrated-ActivHealthCare, and you do not see a member chiropractor on our provider locater nearby, there are a couple of things you can do.

1. You can let your chiropractor know that he is not on your insurance PPO list. Mention Integrated-ActivHealthCare to him and ask him to contact us about membership.
   
   
2. You can contact Integrated-ActivHealthCare and ask us about contacting your chiropractor. If we do not have one in your area, we certainly want to enroll one. We will contact the chiropractor to determine their interest and eligibility.

What happens if my chiropractor leaves the network? Unfortunately, this sometimes happens. There are many reasons for it. If that happens, you can use our online provider locator function to locate a new chiropractor.

How do I change chiropractors? This generally is not a problem, but you should make sure your benefit plan does not have any special rules regarding changing doctors. You can do this by calling the customer service number on your insurance identification card.

There are some things to consider when making a change:

• Changing chiropractors does not mean your benefits for the year start over. Be sure to let the new chiropractor know that you were treated by another doctor. This will help them to accurately determine your financial obligation.
  
  
• Ask your previous chiropractor to provide your new chiropractor with a copy of your medical records and x-rays. This can save you money and help the new chiropractor treat you more effectively.
  
  
• Be sure to clarify the effect of the change on your benefits. Your insurance carrier can advise you of this information.

You can use our online provider locator to help you select a new chiropractor.

What if I have a complaint against my chiropractor? Unfortunately, sometimes people have complaints about medical services. The problems can take many forms. They may be related to customer service, insurance issues, chiropractic office issues or treatment issues.

No matter what the issue, we encourage you to first address it with your chiropractor. In most cases, once you have brought the problem to your chiropractor it will be resolved.

In very rare situations, you may feel the need for additional help. If the problem cannot be resolved between you and your chiropractor, please contact us at Integrated-ActivHealthCare and we will try to help. We will do everything we can to work out a resolution or point you in the right direction.