Billing And Insurance at Move Better

Billing

Piggy-bank and calculatorAfter you have figured out your Insurance, understanding our billing will be very easy. Here is some terminology that will help:

  • Claim: This is our bill that we send to insurance.
  • EOB (Explanation of Benefits): This is a letter the insurance company sends to us and you. It is them telling us how much they will pay and how much you need to pay.
  • Jane: This is the electronic health care and billing system we use to take chart notes and bill out you and the insurance company.

Here is our billing system, if it seems simple, that is on purpose:

  1. After your visit, we submit your claim to the insurance company electronically.
  2. The insurance company takes the better part of a decade to do anything with it.
  3. The insurance company sends us an EOB saying how much they will pay and how much you owe.
  4. We enter that into Jane.
  5. We send you a bill digitally or in the mail when we have real numbers back from the insurance.

Insurance

We accept most major insurance plans as well as provide reduced costs to patients choosing to pay for services outside of insurance coverage.
Many of our peers choose to run a cash practice in order to avoid working with insurance companies. We believe that you already pay a lot of money for your healthcare and we want you to get as much out of it as possible. We also believe that it is important for us to work within healthcare to change their policies to recognize the value of our services. Unfortunately, many healthcare plans do not cover our amazing services or pay so little that we can not accept them.

We currently accept the following insurance plans:

  • Fire and Police Disability and Retirement
  • Regence Blue Cross Blue Shield
  • Premera Blue Cross (BCBS of Washington)
  • ASH (American Specialty Health)
  • Providence
  • Moda
  • Cigna
  • Health Net
  • Pacific Source
  • EBMS
  • First Choice Health Network
  • BridgeSpan Health Company
  • Automotive Insurance (PIP)

If your insurance is not listed you may still have Out-of-Network (OON) coverage.

Healthcare Insurance is a complicated world. We would like to think we know insurance plans in and out, but we are surprised every day by them. As such, it is your responsibility to know and understand your insurance coverage and deductible amount. We recommend reaching out to your insurance provider prior to your appointment to understand how your insurance bills.

Common Insurance Terminology

In-Network (IN)
This means that we have signed a contract with your insurance company and agree to charge our services based on their fee schedule.

Fee Schedule

A list of services and how much an insurance company is willing to pay for those services.

Out-of-Network (OON)

This means that we have NOT signed a contract with your insurance company. This is either because they pay so poorly for the services that we refuse to contract with them or, more likely, they are not allowing any more chiropractors to contract with them.

Deductible

This is how much you will need to pay before your insurance pays anything. You generally have a lower deductible for IN and a higher deductible OON.

Coinsurance

This means that your insurance will pay a certain percentage of the service and then you are responsible for the rest, even after you have met your deductible. They usually cover 80% for IN and 70% for OON. Please verify this with your insurance company.

Co-pay

Generally a small amount that you are required to pay for any visit to any provider.
Office Visit Benefits
This applies to all visits. It is entirely independent of any other services.

Chiropractic Benefits

If you have chiropractic benefits this means that you are ONLY covered for chiropractic manipulation. This does NOT include the movement therapy and soft tissue work that are a cornerstone of our treatment.

Physical Therapy Benefits

If you have physical therapy benefits this means you have coverage for movement therapy as well as soft tissue treatment (manual therapy).

CPT Code

A CPT code is a number that insurance companies use to label a treatment.

Unit

A unit is the amount of paid pieces being used. Generally speaking, a unit is a 15-minute block of a treatment being provided. We usually spend 30 minutes on movement therapy each visit, so this would be considered two units. Oftentimes you may have a limit on units available under your healthcare plan.

Common CPT Codes

Below, we have included the most common CPT codes, units, and costs used for an average follow-up treatment.

  • 99213: Established Patient Office Visit, one unit = $176.28
  • 97530: Therapeutic Exercise = $65.37 per unit. This is a KEY component to treatment as our entire model of health is based on movement.
  • 97140: Manual Therapy/Soft Tissue Mobilization = $47.54 per unit. This allows us to focus on treating muscles and ligaments that may be contributing to your symptoms.
  • 98941: Chiropractic Manipulative Therapy = $81.17 per unit. This allows us to use traditional chiropractic treatment. This service only covers joint manipulation to the spine.

So, let’s put it all together.

A very common follow up treatment could be:

  • 1 unit of 99213.
  • 3 units of 97530.
  • 1 unit of 97140.
  • 1 unit of 98941.
This visit would use 1 Office Visit, a total of 4 units from your Physical Therapy Benefits and 1 unit from your Chiropractic Benefits.

CONTACT US

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Billing And Insurance at Move Better | (503) 432-1061