Everything About Billing

Patients are responsible for making payment directly to 3 Pillars Health for services rendered and for products purchased. Yes, this can be a bit surprising for those individuals who are used to using their insurance at chiropractic offices. We get it that people pay for their insurance coverage and they want to use it! But the truth is that deductibles are getting higher, co-pays are raising and many patients with chiropractic coverage on their insurance plan still end up paying out of pocket for their care. The only exception to this rule is Medicare. See more information on Medicare below. 

We do accept HSA and HRA debit cards and are able to provide receipts for any date of service that a patient would like to submit directly to their insurance company to possibly be reimbursed or to apply towards a deductible. 3 Pillars Health does not submit information to an insurance company on a patient’s behalf. Please note that if a patient’s healthcare plan requires authorization, it will not be beneficial to submit dates of service to the insurance company. See more on insurance authorization below.   

At 3 Pillars Health, we feel that an insurance company should not have an opinion on what is allowed and what is not allowed when it comes to an individual patient’s care plan. Allowing a certain number of visits per year and dictating what types of care are allowed at each visit because a person chose a particular plan does NOT take into consideration that individual’s stressors, posture, diet, physical demands on the job, emotional energy invested into being a parent, etc. But the care plans at 3 Pillars Health DO provide a recommendation based on each of those points. The recommendation for frequency and type of care and supportive supplementation, practices, and exercises are based on the education and clinical experience of a trained doctor of chiropractic who has extensively reviewed a patient history and performed a thorough examination. We promise to be honest with our recommendations. In fact, it’s written right into the 3 Pillars Health mission statement: 

“With authenticity and compassion at our core, we empower health and independence by offering honest, efficient care. Our practice flows with ease and prosperity.”  

Taking insurance can actually be costly for healthcare providers. Offices who opt into being an in-network provider are not allowed to choose which plans to accept and which plans don’t work for their services. Because of this, they are required to accept plans that can actually cost the healthcare providers more time and money than they are reimbursed, putting them in the negative. These plans actually exist! There are more and more of them every year and it is one of the components of third-party providers that have made the insurance world extremely difficult. 

Payment for care and any products purchased will be collected at the time of service. There are several payment options at 3 Pillars Health. The most common approach is to keep a card on file and to be charged at the end of the business day and emailed a receipt. Other patients prefer to keep a card on file to make payment at each appointment, but to be emailed one receipt statement at the end of the month. Cash and check are also accepted and can be provided with a receipt at the end of the business day.  

3 Pillars Health is Currently Unable to Accept Medicare Patients

Participation in the Medicare network is mandatory for all chiropractors caring for Medicare patients, but chiropractors can choose whether or not they want to accept any Medicare patients at all. 3 Pillars Health billing practices currently does not allow for any insurance billing, so we are currently unable to provide services for patients with Medicare coverage.

When the day comes that 3 Pillars health IS accepting Medicare patients, the following information will apply. 

Medicare is very clear about what is considered a covered service and what is not. Active care spinal adjustments are a covered service and will be paid by Medicare. There are non-covered services that are required by Medicare that are the financial responsibility of the patient, such as New Patient Examinations or Re-Examinations. Supportive care such as adjustments of the extremities like the hips or shoulders, soft tissue and muscle techniques, or nutritional supplementation are non-covered services and are the financial responsibility of the patient. 

Each care plan for a Medicare patient will outline what will be covered by Medicare and what will be the responsibility of the patient. Patients are also required by Medicare to sign off on paperwork stating that they are aware of what is a covered service and what is not a covered service each time they elect to partake in a non-covered service. 

Authorization is a part of many insurance plans and simply put is permission to use the benefits of a patient’s own plan. Authorization requires extensive patient testing, specific documentation, and direct communication with an insurance company, usually by phone. Because each insurance company requires a specific form for their authorization, providers may not always be aware of what information is required to obtain authorization at the time of the patient’s appointment and services rendered at that time will be denied for reimbursement. Unfortunately, patients might have go without care while waiting for a response from the insurance company. Because obtaining authorization requires so much from providers, we have opted out of obtaining authorization for chiropractic care. 

For example, a very common scenario is for a plan to allow 12 visits for the entire year but require permission (authorization) for each visit after the 5th visit. In this case, a patient with a flare-up of chronic lower back pain might be prescribed a care plan of two adjustments per week for 4 weeks, then a re-evaluation. This does not align with the insurance company’s requirement for authorization and instead would require a re-evaluation after the 5th visit, before the chiropractor expects to see considerable improvement in the patient’s condition. In this common scenario, the patient would have to use the 6th of their 12 visits to come in for only a re-evaluation, then have a break in care while waiting to hearing back from the insurance company. If they have not shown the improvement the insurance company deems necessary, which is not expected until after the 8th visit, the insurance will deny further care even though the plan allows for 12 visits per year. If the chiropractor decides that it would be detrimental to the patient’s progress to have a break in care and moves forward with the last few visits of the care plan before the authorization is approved, there is a possibility that the insurance company will not make payment for those dates of service and the provider will not be reimbursed for the care provided.

Authorization diagnostic testing such as X-Ray or MRI imaging is usually a much more simple process. 3 Pillars Health will do their best to assist the patient in filling out the required forms.