by Jeanne Kennedy Crosby, D.C.
Open Enrollment for the Affordable Care Act is happening now through the end of January. Now that I have had the opportunity to work first-hand with many of the companies who are offering health plans, I want to give a few pointers for choosing your next plan and/or company. Please remember I only bill insurance in some cases for chiropractic services. Nutrition Response Testing is not billed to insurance.
Providence Health Plans – I am a contracted preferred provider with Providence. I bill personal and group health plans that include chiropractic coverage. This does not apply to Oregon Health Plans managed by Providence, or Medicare Advantage plans managed by Providence. I no longer bill these plans, they are outside of my contract.
No health insurance plan pays very much for my services compared to the actual charges. You see this reflected in your statements from the treatments here if we bill your insurance. Providence generally pays me the best, they are among the most affordable plans (my family uses them) and they’re easy to work with, comparatively. It’s easy to speak to someone there for help on the phone. They don’t require pre-authorization for care. They are really nice and go out of their way to help.
Regence Blue Cross/Blue Shield – I am and will continue to be contracted with Regence for at least the first part of next year (2017.) I am considering leaving this network, even though a lot of you have this insurance. These plans unfortunately do not pay enough for me to continue to add new patients with this coverage to my already very full schedule. They are also really restrictive about speaking to anyone for help when we have questions (they want you to use their website for everything,) and they sometimes require pre-authorization for care. It’s a lot for us/me to manage for their payment rates, which is why I’m re-evaluating my contract with them.
Out of Network Benefits – If you have Moda, Aetna, or United Health Care, generally through your employment, you may have benefits that pay for out of network practitioners. This will cover a small part of your charges, but no discount is applied, like there would be if I was in network. Your portion of the bill that you are responsible for is due at the time of service. FYI, I have repeatedly approached Moda requesting a contract to be in network, and they will not offer me one.
Kaiser – I have repeatedly approached Kaiser requesting a contract to be in network, and they will not offer me one. They do not offer out of network benefits for chiropractic care.
Please remember that many or perhaps all plans (not sure) offer an option to use a Health Savings Account. These are typically Bronze plans. I have one. I use a US Bank affiliated HAS plan, Optum. These are interest-bearing accounts. When I receive any health services not covered by my very basic, no-chiropractic-no-alternative healthcare, only catastrophic-oriented medical coverage, I use the HSA. If you’re buying a personal plan, this is a good way to have a lot of flexibility in whom you see as providers, and the money you run through that account (that’s what I do mostly, I don’t keep money in there very long,) is not taxed as income on your annual federal taxes. The restrictions change yearly for what you can use this for, no supplements, massage must be medical (coded, charted, to address specific medical diagnoses.) Medical massage is billed at $174.00 per hour, so if you are using a health savings account, or a flexible spending account for massage, it must be paid at this rate.