Out of network: what that actually means for your wallet

We do not bill insurance. Patients pay us directly at the time of the visit.

That sentence puts some people off before they have asked a single question about the care, which is fair enough. So here is what it actually means, without the softening language.

What you pay, and when

You pay at the end of each visit. There is no account, no balance that builds up, and no bill that arrives three months later for an amount nobody warned you about.

• First visit: [PRICE]
• Follow-up visit: [PRICE]
• [PRICE — massage, BioMat, and anything else with its own rate]

The front desk will tell you the cost before you book, and again before you commit to anything ongoing. Nobody here sells a package on the spot, and you will never be asked to sign up for a course of care in the same conversation where you first heard the price.

We take cash, card, HSA and FSA.

What we give you for your insurer

After the visit you get an itemised receipt with everything a plan needs to process an out-of-network claim: the date, what was done, the procedure codes, the provider’s details and the amount you paid.

[CONFIRM — is this a superbill, and does the front desk submit it on the patient’s behalf or hand it over for them to file?]

You send that to your insurer. If your plan has out-of-network benefits, they reimburse you directly according to whatever your plan says.

The part we cannot promise

We cannot tell you how much you will get back.

Out-of-network reimbursement depends on your specific plan, your deductible, whether it has been met, your plan’s allowed amount for each code, and your coinsurance rate. Two people can hand in identical paperwork and get back very different amounts, and neither of them did anything wrong.

Any practice that tells you what your plan will reimburse is guessing. We would rather say plainly that we do not know.

Four questions worth asking your plan

Call the number on the back of your card and ask:

1. Do I have out-of-network benefits for chiropractic care?
2. What is my out-of-network deductible, and how much of it have I met this year?
3. Once the deductible is met, what percentage do you reimburse?
4. Is there an annual limit on chiropractic visits?

Fifteen minutes on the phone gives you a real answer instead of a hopeful one. Write down who you spoke to and when.

Why it works this way

The short version is time.

Billing insurance means practising to what a plan will authorise, and it means a portion of every week going into claims, resubmissions and appeals. A small practice that takes that on either hires for it or takes it out of appointment length.

Not billing means a first visit can run an hour because an hour is what it needs, and that the conversation at the start does not get cut short to make the schedule work.

That is a genuine trade and it does not suit everybody. If cost is the deciding factor and your plan has good in-network chiropractic coverage, using it is a reasonable decision and we will not try to talk you out of it.

If the cost is the problem

Say so. Call the front desk on (607) 266-4325 and ask.

It is a conversation worth having before you decide you cannot come, and it is one we would much rather have than have someone quietly not book.