Chiropractic Services

Feb 22, 2016

  1. LewB
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    LewB Expert

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    I was with a prospect on Friday and she told me her sister goes to a chiropractor and the chiropractor bills Medicare. She told be that her sister has a bad back and the doctor has recommended physical therapy and chiropractic care.

    Is anyone familiar with cases in which Medicare will pay for chiropractic services?
     
    LewB, Feb 22, 2016
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  2. TDFnCali
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    TDFnCali Guru

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    Medigap & You 2015 Booklet.....

    Chiropractic services (limited coverage)
    Medicare covers manipulation of the spine if medically necessary to
    correct a subluxation (when one or more of the bones of your spine
    move out of position) when provided by a chiropractor or other qualified
    provider. You pay 20% of the Medicare-approved amount, and the
    Part B deductible applies.
    Note: You pay all costs for any other services or tests ordered by a
    chiropractor (including X-rays and massage therapy).
     
    TDFnCali, Feb 22, 2016
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  3. LewB
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    LewB Expert

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    TDF, thanks for taking the time to answer my question but I am still a little confused about who gets to determine if its medically necessary. Can the chiropractor determine that or does a medical doctor need to recommend it?
     
    LewB, Feb 22, 2016
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  4. kgmom219
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    kgmom219 What's Next?

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    Referrals are not required. But here's how I handle that question(since EVERYONE'S aunt gets chiro covered) during the sale:

    Me: "Most Chiropractic Services are not covered"

    Me: "Do you use a chiropractor?"

    Client: You either get a Yes or No. Very emphatic either way. If they say no, you say "good, because most of it isn't covered anyway". If they say yes, direct them to the chiropractor. "Covered chiropractic services are very specific and require the procedure/diagnosis codes to determine if they are a covered benefit. Definitely speak with your chiropractor. I can't even begin to guess if your treatment is covered. Just remember, its subject to the Part B deductible and copays under Plan N."

    So now the client is going to go to the Chiro, who has figured out how to get Medicare pay for his services. And if for some reason at a later date, Medicare rejects the claim, its not your fault.
     
    kgmom219, Feb 22, 2016
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  5. LewB
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    LewB Expert

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    Thanks for the info.
     
    LewB, Feb 23, 2016
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  6. somarco
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    somarco That Medicare Expert Guy

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    Medically necessary

    Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.

    https://www.medicare.gov/glossary/m.html
     
    somarco, Feb 23, 2016
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  7. sman
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    sman Guru

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    Well that's a sexist statement!!! Why does the Chiro have to be male?

    This is of course a joke so don't everyone get offended. :twitchy:
     
    sman, Feb 23, 2016
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  8. kgmom219
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    kgmom219 What's Next?

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    You know, I never thought about it (and I am absolutley NOT offended), but I have met at least 50 chiro's in my life and ALL of them were male.

    What's up with that???
     
    kgmom219, Feb 23, 2016
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  9. HoosierLife
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    HoosierLife Want to write $20,000+ Guaranteed? bit.ly/learnfe

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    I had one female Chiro. She was painful. And ran her business like a factory. Everyone would come in at the same time and take a number. She had two tables and switched hit between the two of them.

    I didn't stay there long.
     
  10. sman
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    sman Guru

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    The very first chiropractor I ever saw was a female. There are couple female chiropractors here in my town.
     
    sman, Feb 23, 2016
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