How to use out-of-network medical insurance benefits?
Some medical insurance plans through PPOs like Regence, MODA, and Providence reimburse up to 70% of out-of-network “medically necessary” services such as chiropractic, acupuncture, massage therapy, and physiotherapy.
This reimbursement is paid directly to you through your out-of-network medical insurance benefits.
How to use these benefits?
Step 1: Book + Pay at the time of your session
You pay the regular session fee at the time of service (just like normal). Because I’m not in-network with insurance companies, my fees are SIGNIFICANTLY lower than many other chiropractic clinics simply because I don’t have to play haggling games with insurance companies. This ultimately means a lower out-of-pocket cost to both you and your insurance.
Step 2: Request a Superbill
During your session, ask me for a superbill. This is a special receipt that includes:
Date of service
(CPT) Treatment codes: Exams [99202-99204 & 99212-99214] Soft Tissue/Stretching [97140, 97530, 97124], Spinal Manipulation [98940-98942] Extremity Manipulation [98943], Strengthening/Stretching/Stabilizing Exercise [97110, 97112]
(ICD-10)Diagnosis codes: For example [M54.50 Low back pain], [G44.219 Episodic tension-type headache, not intractable], [M62.838 Muscle Spasm], etc.)
My NPI number and business info
Because I’m trained and licensed in the state of Oregon to use chiropractic, physiotherapy, and massage therapy codes, your insurance has a better chance of approving it.
Step 3: Submit It to Your Insurance
You submit the superbill to your insurance company’s claims department (usually via their website, portal, or mail).
Within a few weeks, they’ll send you a reimbursement check based on your plan.
Unsure if you have out-of-network benefits?
1) Login to your medical insurance online portal and read through your benefits section to see what your coverage entails.
2) If you’re still unsure what your insurance covers, feel free to call your insurance company and ask:
“Do I have out-of-network benefits for chiropractic (98940–98943), physiotherapy (97110, 97112, 97530, 97140), and/or massage therapy (97124)?” Then let me know either in your intake forms or during your session what your insurance covers and I will code accordingly!
I’m happy to help you interpret your coverage or walk you through the process.
What’s up with Medicare Coverage?
I do not bill out to Medicare as it does not pay for the following services performed by chiropractors:
Health history reviews/physical exams
Soft tissue and myofascial release
Stretching
Nervous system calming techniques
Strengthening/stretching/stabilizing exercises (ie weight training, stretches, fall prevention)
Diet/general lifestyle counseling
Over-the-counter medication/supplement recommendations
Even though we are licensed and trained to do what is listed above, the only chiropractic service Medicare covers is spinal manipulation. I rarely perform traditional chiropractic high-velocity spinal adjustments (“cracking”) and even less frequently on aging spines. This is because most of my older patients coming in for headaches, stiffness, jaw tension, hip pain, posture fatigue, back pain, and balance issues respond better to the slower low-force soft tissue and rehabilitation focused treatments as opposed to a quick crackin’ session.
Hopefully this helps you better understand your insurance benefits! As always, feel free to email me with any questions you may have at info@longevitychiropdx.com.
See you soon!
- Dr. Andy
