Medicare
Medicare and coverage, in plain words
Medicare covers only spinal manipulation. Exams, x-rays and other services are not covered. Here is how that works at this office.
| Service | Medicare Part B | At this office |
|---|---|---|
| Spinal manipulation | Medicare Part BYesCovered when it is needed. You pay 20% of the approved amount after your Part B deductible. | At this officeWe bill Medicare for you. |
| Exam | Medicare Part BNoNot covered | At this officeWe tell you the cost in writing first. |
| X-rays | Medicare Part BNoNot covered | At this officeTaken only when medically necessary, and only with your OK. |
| Soft tissue work | Medicare Part BNoNot covered | At this officeWe give you an ABN and the cost on paper, and you decide. |
| Movement coaching | Medicare Part BNoNot covered | At this officeWe give you an ABN and the cost on paper, and you decide. |
How a visit goes
A Medicare visit, step by step
- 1
Step 1: Call, or bring your card
The front desk looks at your Medicare card and any other plan card, and tells you what we can bill.
- 2
Step 2: Your doctor explains
Before care begins, your doctor says which part of the visit Medicare covers and which part it does not.
- 3
Step 3: An ABN, if it is needed
For a service Medicare does not cover, we give you an Advance Beneficiary Notice with the cost. You choose, and you can say no.
- 4
Step 4: We bill Medicare
We bill Medicare for spinal manipulation. You pay 20% of the approved amount after your Part B deductible.
- 5
Step 5: A receipt, every time
You leave with an itemized receipt, so you can see what was billed and what you paid.
ABN
What an Advance Beneficiary Notice is
A form Medicare asks us to give you before a service it may not cover.
What it says
It names the service, says why Medicare may not pay and gives the cost.
When you get it
Before the service, never after.
What you do
You read it, ask questions and choose whether to go ahead. You can decline the service.
Questions
Questions about Medicare
Does Medicare pay for my first visit?
Medicare covers only spinal manipulation, so it does not pay for an exam or an x-ray. We tell you the cost of those in writing before your first visit.
I have a Medicare Advantage plan. Is it the same?
Not always. Each plan sets its own rules, so call us with the name of your plan and we check before you come in.
I have a Medicare supplement plan. What does it pay?
A supplement plan may pay some or all of the 20% you owe. It does not make Medicare cover more services. Your plan has the final say.
What if I do not want to use Medicare?
You can pay for a visit yourself. If you do not use insurance, you have the right to a Good Faith Estimate. Ask us.
Bring your cards, and your questions
The front desk will go through it with you.