What is a superbill? Insurance questions answered by a chiropractor
by Dr. Kayla Long, D.C.
Health insurance is both extremely necessary and needlessly complicated. Most people have it, but not everyone knows how it works. I’ve put together a basic guide for how health insurance works in relation to chiropractic care, based on everything I’ve learned from billing insurance for chiropractic care for my entire career.
In-network Insurance Benefits:
If your insurance plan includes chiropractic care, this section is for you.
Your healthcare plan may use a deductible, a co-pay, or both. A deductible (typically in the thousands) is the amount you have to pay towards healthcare before your plan will start covering costs. This means you are responsible for 100% of the “allowed amount” of the service. In the case of chiropractic adjustments (except the first appointment which includes an exam), that is usually between $20 and $60, depending on the company. It may take a while before you meet your deductible amount, but once you do, your insurance kicks in either a percentage of the cost or the full cost of the appointment. So, if you go to the doctor a lot or have surgery, your deductible gets met faster and your out-of-pocket cost might be $0 for the rest of your appointments that year.
A co-pay is a slightly different system. The co-pay is a set amount that you pay out-of-pocket for every visit, and your insurance covers the rest. So, if you have a visit that costs $60 but you have a $25 co-pay, you are only responsible for the co-pay and your insurance covers $35. This set-up typically also includes a visit limit for the year. Once you have hit the number of visits on your plan, insurance will no longer cover care and it’s an out-of-pocket cost to you until your plan resets.
If your plan has both a deductible AND a co-pay, it just means that once you have met your deductible for the year, you then have a set co-pay per visit. So, instead of being responsible for the entire cost, you might have a $10 co-pay per visit.
You will probably also have an out-of-pocket maximum. This amount indicates the absolute limit for what you will have to put towards in-network healthcare costs for the year, and once you’ve met this amount, your out-of-pocket cost for visits is $0. Even if your plan was a set co-pay amount, if you meet that OOP max, your co-pay is now $0.
Medicare is a little different. Medicare plans do cover chiropractic care, but in a very limited way. Medicare only covers spinal adjustments. So your New Patient Examination, done during your first visit at any chiropractor’s office, is an out-of-pocket cost to you. After that point, the only thing covered during your appointment is the spinal adjustment. If you request a shoulder adjustment, soft tissue work, an ankle adjustment, or anything outside of the spine, it’s not covered by Medicare.
Out-of-network Insurance Benefits:
If we aren’t in network with your insurance, no need to fret! We still have options. A lot of healthcare plans have out-of-network benefits. It just looks a little different. Instead of Longevity Chiropractic directly billing your insurance, we can provide a Superbill. This is essentially a receipt, except that it contains all the information we would use in an insurance claim (procedure codes, diagnosis codes, etc) along with the amount you paid for your visit. You then submit that to your insurance company, who directly reimburses you for care.
Not all healthcare plans have out-of-network benefits, but if you have those benefits, use them!
If you have questions about insurance, how it works, or what you might be expected to pay for chiropractic care, please don’t hesitate to ask. We can look up your insurance information in the office and give you the information you need based on your specific situation.
Kayla Long, D.C.
Longevity Chiropractic
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