While individual policies vary, there are a few things that are perfectly clear about insurance coverage and chiropractic care. One of those is that since January 1, 2000 any policy written in the state of Connecticut MUST include chiropractic care(‘self-funded’ plans have the option of excluding it, and anything else they choose). Having said that, it’s then up to each individual company to outline just exactly what that coverage will be…and they do vary quite a bit…with some it’s limited in office visits, others may limit procedures. But overall, benefits for chiropractic care are uniformly granted. Why?? Simple…chiropractic works! And insurance companies know it keeps people healthier – which in turn saves them money(big surprise there, right?). If something saves an insurance company money, they’re all for it!!
Having been in practice for almost 20 years, I’ve noticed the change in insurance coverage from the straight old ’80/20′ or ’70/30′ plans(meaning insurance pays 80%[or 70%] and you pay 20%[or 30%] after a deductible was met) in the early 90’s, to the straight HMO/PPO models which started incorporating fixed co-pays each visit – which was helpful in knowing that your cost each visit was fixed (at the time at $5 or $10). This was done to lower premiums, but it opened the door to liability when care was denied by HMO doctors(who worked for the insurance companies and whose jobs existed on cutting benefits and services).
Over time, the insurance companies raised premiums, raised co-pays and reduced benefits. I see and hear about those “In-Network” co-pays, that were supposed to aid in reducing YOUR out-of-pocket costs being as high as $35-$50/visit, and more-and more the look of going back and only paying 20% of an office visit is cheaper!
Based on this, I’ve decided to go “Out-of-Network” with insurance companies since 2006. The benefits outlines for “In-” and “Out of Network” physicians in the policies are identical, but the cost to the patient is reduced, since they’re only responsible for 20% or 30%(in most cases). For example: If you have a $40 co-pay with a Blue Cross ’80/20′ policy , and the visit total is $150, you’re only responsible for 20% of that ($30) using your “out of network” benefits when you would have to pay $40 going to an “in-network” doctor. The advantage for the in-network doctors only seems to work when co-pays are lower, and since they’re not low anymore, “out of network” benefits become superior. So, be wary of the belief that going to a PPO provider is cheaper, but most likely it’s cheaper for the insurance company, and not necessarily for YOU!