Insurance Deductibles & CoInsurance

Some insurance policies require the patient to pay a deductible before the insurance company begins covering services. The deductible amount varies depending on the insurance company and the specific policy.

Often, once the deductible is met, the patient will still have a co-insurance. This means the insurance company covers a percentage of the allowed amount, and the patient is responsible for the remaining percentage.

If the deductible applies to chiropractic services, the insurance company will not pay anything toward those services until the deductible has been met.

Some insurance plans have a set co-payment after the deductible is met. This is why it is very important to verify benefits carefully and confirm exactly how the plan processes chiropractic claims.

Allowed fees are the maximum amounts an insurance carrier allows for a specific service. These allowed amounts are what we use to calculate the patient’s responsibility per visit.

Deductible: $500 Met: $400 Remaining deductible: $100

This means:

Deductible: $1,000 Met: $735 Remaining deductible: $265 Insurance coverage after deductible: 70% Patient responsibility after deductible: 30%

This means:

Important note: When a patient has a high deductible, especially $2,000 or more, it may be more affordable to offer them the option to be a cash patient. This is especially true for maintenance care, since maintenance treatment often does not need to be billed through insurance.