How Much Will This Cost?
Is Chiropractic Right For Me?
Most times, yes. In 2015 the American College of Physicians called for alternative treatments such as manipulative therapy, exercise therapy and massage therapy to be used first, before pain management, medications or surgery. Pain medications and the opioid crisis have cost thousands of lives. In fact, 80% of heroin addicts cite prescription pain medication as their first exposure to opioids. Additionally, back surgeries have many risks and are really only meant to relieve radicular leg and arm pain NOT lower back pain.
Care is typically more affordable than you may think. Treatment costs can be significantly less than medical costs and far less than surgery, pain medications or injections. While most insurance companies have some level of coverage for chiropractic care, most do not cover our services at the same level they will for drugs and surgery. Despite the fact that chiropractic care has been shown to be safer and have better long-term benefits for treating back pain, most insurance companies will still have better coverage for drugs and surgery.
So, What Will it Cost?
This is probably the most common question we get from new patients and it’s also one of the most difficult for us to answer accurately without first getting to know you, your health history and condition. It is very difficult to determine what it will cost up front because each patient has very different needs and we always tailor your care plan to meet those individual needs. Additionally, treatment plans will change as your condition changes or improves. This is one of the reasons we offer a FREE CONSULTATION so that we can get an idea of what your treatment plan could look like and if our treatment is right for you.
Steps To Determining Costs
First, we must determine the cause of your problem and if this is something we can treat or if it will require more urgent medical attention. Fees vary depending on the complexity of the exam and the length of time our physicians spend with the patient. New patient exams range in cost from $75 for our basic exam to more than $200 for detailed and complex exams.
Type of Treatment Needed
Once we get to know you, your health history and the cause of your pain, we can determine what TYPE of care you will require. Chiropractic is a profession but manipulative therapy is not the only way we can treat you. Most of our patients will receive a plan that will cover many modalities and could be covered by their insurance under medical care, chiropractic care or physical therapy. Your examination and treatment plan will be tailored exclusively for you.
How Much Treatment is Needed?
We respect your time and money and we understand the difficulties that lengthy appointments can create. For this reason, we set goals and expectations for your care and we prescribe the minimum care we feel is necessary to achieve the best outcome. With functional based care (like chiropractic, physical therapy, or even just going to the gym) you need frequency and duration of treatment in order to obtain optimal results. These care plans will last from 4-6 weeks with 10-12 visits. Some acute care plans may be as few as 3-6 visits, depending on the condition and any past treatments you may have received.
Costs of Treatment Plan
Now that we know what the problem is, what treatments are most appropriate and approximately how much treatment you will need, we can put together a plan with actual costs. A typical treatment plan for a new patient with an uncomplicated lower back pain will range from 6-12 visits and from $300-$1,800. Most initial treatment plan costs will fall within this range with or without insurance coverage.
So, What Does My Insurance Cover?
Good question! This is quite confusing and seems to continually change each year! The good news is we will determine this for you before you begin any treatment. We have highly skilled Patient Care Coordinators who will work with you to help determine what your best options are and can even set up convenient payment plans to spread out the up-front costs to fit your budget.
What is a deductible?
This is the amount you are responsible for paying before your insurance company will cover any of the expense. For example, if the total cost of your treatment is $1,000 and you have a $500 deductible, you pay the first $500 then your insurance will pay the remaining $500.
What is a copay?
This is a set amount you may owe per visit, regardless of what is done or billed. For example, if you have a $20 co-pay and we prescribe a 12 visit treatment plan, you will owe $240.
What is co-insurance?
This is a percentage owed based on the total bill for that visit. For example, if the total bill for a visit is $110 and you have a 20% co-insurance, you will owe $22 for that visit.
How does coverage work?
Here are 2 examples of how a deductible with a copay versus a deductible with coinsurance would work.
Your treatment plan is set and we have prescribed a 12-visit plan that is covered by your insurance at the contracted rate of $1223.
- You have a $300 deductible and 20% co-insurance. You pay your $300 + $184.60 (co-insurance) for a total cost of $484.60. Your insurance plan should pay the remaining balance of $738.40.
- You have a $300 deductible and $20 copay. You pay your $300 deductible (which would be met in the first two visits) +$20 for the remaining 10 visits for a total cost of $500. Your insurance plan should pay the remaining $723.
What insurance plans do you accept?
We accept most insurance plans but it is important to remember most insurance plans are purchased by a person’s employer and companies can choose the level of services they provide. This means that not all BC/BS plans are the same or have the same level of coverage for services.
- Anthem BC/BS
- Medical Mutual of Ohio
The following companies have limited coverage and prior authorization requirements that can be difficult when obtaining adequate coverage. It is best to call and check with us beforehand if you have coverage with any of these carriers.
- United Health Care
- Mercy Health
What about Medicare and Medicaid?
These are Federally Funded Health Insurance Plans and have their own set of rules and guidelines:
- United Healthcare Community
We do accept these plans, but they create a great deal of confusion when determining coverage. Unfortunately, Medicare and Medicaid plans have extensive limitations for coverage and do not cover the full scope of services we offer. They ONLY cover spinal manipulation (which is a treatment). They DO NOT cover the entire scope of “chiropractic care” a patient will require. Specifically, the patient examination fees which are a required by any standard of care including Medicare’s.
What this means is that Medicare and Medicaid require an examination to meet the medical necessity of performing spinal manipulation, but they DO NOT COVER payment for the examination! In addition, Medicare and Medicaid recipients are not eligible to receive any promotional offers or free services.
Sorry, we don’t make the rules we just try and follow them even though they make no sense. We also urge all of our patients with Medicare or Medicaid to contact state and federal legislatures to get this goofy rule changed and to cover all services that are within our scope of practice. This has been an ongoing struggle with our profession and your voice does make a difference.
What about Workers' Compensation?
We are an Ohio Bureau of Workers Compensation certified provider and are willing to accept new patients as physician of record (POR) on all new and even older cases. We take all cases, even if they do not require therapy or treatment at our facility. All of our fees are billed directly to the Ohio BWC in accordance with their policies. Treatment requires prior authorization but the consultation and examination does not and is typically covered on active and allowed cases. You are entitled to choose a physician of record of your choice. You do not have to use the occupational medical center or company doctor.
I have been injured in an auto accident.
- Auto Accidents
- Personal injury claims
- Attorney letter of protection
If you have been injured in an auto accident, we offer treatment options that will allow you to get the care necessary without having to wait for a settlement with an insurance company. We have extensive experience in treating these cases and can get you the help you need without having to worry about paying the up-front costs.
Due to the complexity of these cases and the nature of med-legal cases, we do not offer any time-of-service cash discounts and we do not participate in any contracted reduced fee schedules. We accept medical payment, auto insurance or an attorney letter of protection on these cases and typically do not use health insurance plans.
Please call us at (330) 726-7404 with any questions or visit our Auto Accidents Page to learn more.
What if I don't have any insurance coverage or my deductible is really high?
We have many options for those with high deductible plans or no coverage. We offer time-of-service cash plans along with payment plans that can spread the upfront cost of treatment out beyond your time in our office, making your treatment affordable.
Please call us to schedule a consultation and one of our billing specialists will be happy to verify your coverage and review your options. If you do not have coverage and you’re unsure of the costs, schedule a FREE CONSULTATION to help you better determine what treatment will cost.
What Are Our Patients Saying?
Advanced Chiropractic & Rehab, Inc. is dedicated to patient health and satisfaction.