Be Truly Well Chiropractic & Day Spa Frequently Asked Questions (FAQ)
I haven’t been to see the Doctor for 3 or more years. Why do I need to have a new patient examination?
According to CMS Guidelines, you are now a new patient. If it has been 7 years, we may not have your previous records, as old files are destroyed after 7 years, much like tax records. Here is a piece from CMS:
“Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years.
For example, if a professional component of a previous procedure is billed in a 3-year time-period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient. Beginning in 2012, the AMA CPT instructions for billing new patient visits include physicians in the same specialty and subspecialty.”
I don’t have insurance or my insurance doesn’t cover chiropractic care. How much will my visit cost? Do you have a cash discount?
The Office of the Inspector General (OIG), approves a discount of 5-15% for patients for prompt payment. While we are happy to offer that discount, it is still too expensive for many patients. This OIG approval applies to both insured and uninsured patients, regarding the reasonable discount amount of 5-15%. For this reason, we are a participating provider with ChiroHealth USA, a Medical Discount Plan.
Members of the discount plan will receive a 50-60% discount, with a capped value per visit, on Chiropractic Care that is not covered by their insurance. We are not a provider with another Medical Discount Plan, but other chiropractors may be. You can find a listing of participating providers with your Discount Plan. Signup is done right at the office. Please speak with a front desk receptionist or our Manager for cost, as it varies according to medical procedure costs. Here is an excerpt from the OIG approval:
“The Office of the Inspector General (“OIG”) issued Advisory Opinion No. 08-03 on February 8, 2008, which approves a health system’s plan to offer prompt payment discounts to federal health care program beneficiaries and other insured patients for inpatient and outpatient services. The proposed plan would provide discounts ranging from 5 percent to 15 percent
to all patients for prompt payment.”
I have Medicare. What’s covered?
Medicare covers spinal manipulation for acute treatment only with the number of visits ranging from 12-30, depending on the Doctor’s diagnosis of the condition. Beyond that, any examinations, re-evaluations, maintenance care, or extremity (shoulder, arm, hip, leg, etc) adjustments are the patient’s responsibility. Patients are welcome to use a Medical Discount Plan such as ChiroHealth USA to help offset the cost of these non-covered charges. We are required to go over all costs with Medicare patients before they receive treatment so that there are no surprise charges. You will be asked to fill out an Advanced Beneficiary Notice where you will choose how you will proceed in regards to the non-covered treatment.
Covered charges will be subject to Medicare’s Part B deductible and 20% co-insurance. If you have a supplementary plan, you may have further coverage on those charges, however, the non-covered charges will remain full patient responsibility.
I only need a quick adjustment. Why do you want me to come in so often?
It’s important to realize that while you may feel fabulous when you leave the office, one chiropractic adjustment will not solve most problems. The body will unwind and often the adjustment will not hold past a day or two in the first phases of treatment. Therefore, more frequent adjustments are needed to continue to improve the underlying problem. While there is no set number of visits to help a patient resolve an acute condition, ideally a patient will move to sub-acute treatment within 6-8 weeks. After a re-evaluation, the Doctor will recommend whether further treatment is required to improve or whether maintenance is recommended. Once a patient reaches a maintenance level of care, they are left with a decision to continue treating and pay for care, as it is not covered by most health insurance plans or to wait until they have an exacerbation of their condition and require more frequent visits, which would not be considered maintenance. The doctor will go over how often he feels you will need to be seen for the best results within your first week of treatment.
For chronic conditions, on-going treatment is often needed. Maintenance level of care is reached when a condition will not further benefit from treatment, but the level of comfort will be maintained by continuing care. Again, this will require a decision on the part of the patient regarding their lack of coverage for such care.
I’ve been treating for a few months or haven’t been in for a month or so. Why do I need a re-evaluation?
We are required to provide proof of medical necessity to your Insurance Carrier for claims being submitted to them. Most plans do not cover Maintenance Care, and therefore we need to provide documentation to show any changes in your condition to differentiate between Active Care and Maintenance Care. A re-evaluation by the doctor allows us to have the medical findings needed for us to properly determine whether your treatment requires any changes, what percentage of Maximum Medical Improvement you have reached, and whether or not you are near or at a maintenance level of care. For more information on Maintenance Care, we have a brochure available to review.
“Based on these five tenets, a time for re-exam can be extrapolated that would fit most claims. The generally accepted time needed for chiropractic services to demonstrate improvement is about 30 days, per the American College of Occupation and Environmental Medicine Occupational Medicine Practice Guidelines, Official Disability Guidelines and the Mercy Guidelines. Therefore, in absence of new complaints or flare-ups, a re-exam is done approximately 30 days after the initial exam…. If these guides are used to demonstrate the necessity of the service, there would be no issue with the time being shorter or longer, as the specific necessity would be documented.”
This is my fist massage. What should I expect?
Welcome! We’re glad you’ve chosen Be Truly Well and our Licensed and Certified Technicians for your spa service. All massages are performed in a private room with your therapist. You will be covered by blankets and only your back, arms, or legs will be uncovered at any given point during the massage. Your level of undress is to your comfort, always keeping lower undergarments on. Please have an open line of communication with your therapist so that she can tailor the pressure to your needs. Spa treatments are not of an intimate nature and therapists will respect your privacy at all times.