Health Insurance Confusion

I am very excited to announce that I have recently been credentialed with Blue Cross Blue Shield of Texas and Humana. So as an added service, Tranquility Chiropractic Studio will now be billing most patients’ health insurance!

What has been interesting about this change, is how little people including myself know about their health insurance benefits.  It is interesting how many of us go to our health care provider and know little to nothing about what will and will not be covered.

Does my plan cover chiropractic?  Do I have a copay or coinsurance?  What is my deductible?  What is a deductible?  If I have a copay, is a chiropractic visit considered an “office visit” or a “specialist visit”?  Do I need my PCP’s referral?  What will I get stuck with after my insurance company pays the doctor?  Am I responsible for the amount insurance company doesn’t pay to my doctor?  Augh!!!!!!!!!!! Health insurance can be very confusing!

I had waited months to become credentialed, and here I was too…confused! In order to better understand how to help my patients get the care they deserve, I met with a billing specialist (as well as called every chiropractor I knew).  I talked for hours and asked a million questions.  Here are a few tips that I think can benefit every person who has or ever will have health insurance.

Common Insurance Questions and Answers

1. What is a deductible? I like to think of the deductible as your upfront out-of-pocket cost.  Your deductible is the predetermined amount you are responsible for paying before your insurance company will start covering your health care expenses.
2. How often do I have to meet my deductible? Your deductible starts over again annually, but don’t be shocked if your health coverage isn’t from Jan 1-Dec 31.  I’ve seen other dates (IE Sept 1- Aug 31).
3. How is my deductible determined? The lower your deductible is, the higher the price of your plan (usually paid monthly).  If you have a lower deductible then your insurance company will pick up a larger portion of the bill.
4. Who is responsible for billing the insurance company…me or my doctor? Many health care providers bill the insurance company as a service to you, but it is ultimately the patient’s responsibility to ensure that provider is paid for his or her services.  Whoever bills the insurance company has the most risk of revamping the cost of service!  Please remember, if your insurance company doesn’t pay, you may have to! So if your provider bills for you, make sure you understand what amount you are responsible for if the insurance company decides not to pay for part or all of your care.
5. My insurance company didn’t pay for my treatment and my doctor wants me to pay.  Who’s fault is it…my doctor’s or my insurance company? So you’re in a situation where your insurance company did not pay for part of your services, and your doctor is asking you to pay the amount not covered.  Frustration can arise when you get an unexpected bill, but stay calm.  Either party could have made an error- your doctor’s office may have billed the claim incorrectly or the insurance company could have paid or not pay the correct amount.  If you get a bill from your provider’s office, call and ask why the services were not covered.  But remember, if your insurance provider doesn’t pay, ultimately you are responsible.  Luckily, most doctors are doctors because they love to help people.  So always assume your doctor will work with you to make sure you can afford your care!

For more information, check out these links!

http://www.healthcarecoach.com

http://personalinsure.about.com/od/health/a/aa032805a.htm

http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/dc/cen/hea/misc/alert10152007.jsp

Taking a little stress out of your day!  -Dr. Funk

Overcoming Stress: Giving Yourself Permission to Relax

A few months ago a local acupuncturist hurt her low back while she was gardening and approached me about a trade.  I had just started Tranquility Chiropractic Studio and was not used to hours of massage and manipulation.  Due to all the work, I had developed joint pain in my fingers, wrists, and elbows, so I agreed to come in for treatments.

The first day I went in for my acupuncture treatment, I marveled at her amazing office and assortment of herbal teas.  I sat down with a cup of cranberry tea and thumbed through her baby book (she specializes in fertility treatments) waiting for my initial consultation.

A few minutes later, the receptionist called my name and took me back to my room.  She gave me a hot towel to wipe my hands and feet and asked me to lie on a comfortable bed.  I relaxed for a few minutes and waited for my consultation…

By the third treatment, my joint pain had started to subside (minus the pain brought on by possibility that treatments could increase my fertility).  There was only one problem- IT WAS SO HARD FOR ME TO LIE AND RELAX FOR THE 45 MINUTE SESSION. I kept thinking about all the things I should be doing: filling out credentialing applications to become an in-network provider, harassing local businesses with my amazing fliers, cold-calling to set up my chair massages, dinner with my boyfriend that evening…  I just couldn’t get myself to relax!

That’s when it hit me…I needed to give myself permission to relax.  There was nothing else I should be doing at the moment.  I should be relaxing. At that moment with that realization, I was able to reconnect with the soft rise and fall of the ocean waves playing in the background- reconnect with steady in and out of my breath.  My heartbeat slowed, my mind relaxed, and I fell asleep.

Working Every Day To Take A Little Stress Out Of Your World!