UnitedHealthCare (UHC) is a high quality health network with very good benefit plans for its policy owners toward chiropractic and other medical doctors. Here is a breakdown of the information about your plan that determines what you will owe for your visit.
Deductible: The total amount of all medical costs you have to pay each year before your insurance plan begins to pay for your care. UHC normally has $0 or very low deductibles which saves you a lot of money when receiving health care. Their are normally 2 types of deductibles; individual and family. Whichever you have met first triggers the next section.
Co-pay vs Co-insurance
Depending on your particular plan, after the deductible has been met you will either be required to pay a co-pay or a co-insurance.
Co-pay: A set fee you pay each time you receive medical care. This will usually range from $10-$40.
Co-Insurance: A percentage fee you pay each time you receive medical care. This is normally 20% and normally comes out to about $20.
Out-of-pocket limit (Stop-Loss): Health care costs you have to pay with your own money. This is a maximum most insurance plans have where if the patient spends a certain amount of their own money on their healthcare costs, in a given year, their co-pays and co-insurance get set to zero. This is usually a very large number that most people never reach without having to undergo surgery.
Health savings account (HSA): An account a person or employer sets up to save money for health care costs. All your services at our clinic can be payed for with a HSA.
Visit Limit: This is the number of chiropractic visits covered by your insurance policy in a given year. Most UHC plans have an active care approach and normally have no set visit limit. Each new injury or flair up of an existing problem requires the chiropractor to submit a new problem report to your insurance company which then must be updated every 5-10 visits in order for them to re-asses whether they believe more treatment is required to fix the problem. Note: even though they don’t cover chronic problems, every new flair up in those chronic problems are covered. So make sure to tell the chiropractor so he can update your file with a new incident date for the insurance company.
Exclusions (limitations): Medical services that aren't covered by the insurance plan. UHC covers all chiropractic services, with the exception of massage which gets treated as a separate cash only service.
Denial of claim: When an insurance plan refuses to pay for a certain health care service. Chiropractic does not require a referral with UHC and thus don’t deny our claims. This usually will only occur if you go to an MD specialist (osteopath, neurologist) or get advanced diagnostic imaging (MRI, CT) without a referral and pre-approval by your insurance company through your primary physician or chiropractor.