Medicare Coverage for Chiropractor Services

Medicare coverage for chiropractor services can cause billing problems.  That’s because Medicare covers certain services among the many things a chiropractor does for a patient – and the patient could end up with a very big bill she thought would be paid by Medicare.

I got an email from a reader of this blog (Let’s call her “Sue”.) who ended up with a $2,000 bill from her chiropractor. On her first visit, Sue asked the chiropractor if he accepted Medicare and was told he did.  Sue figured she would have no co-pays because she has Medicare and a Medicare supplement. She got no bill for six months and then…… was handed a bill for $2,000.

Medicare coverage for chiropractor services is limited to “manipulation of the spine if medically necessary to correct a subluxation“.

The problem was that the chiropractor did much more than “manipulate” Sue’s spine. Sue brought the bill to the chiropractor’s office and pointed out that she was never told that most of her treatments would not be paid by Medicare. Sue was told, “too bad”…  because she had signed an ABN (Advanced Beneficiary Notification) that says she must pay whatever her insurance does not pay.

Sue was not happy and was not about to pay that bill.  She called Medicare. She called the state Chiropractor Examiner’s Board. And she wrote letters and emails to the chiropractor to dispute the bill.  It took a while, but the chiropractor eventually gave in.  The chiropractor even had a lawyer on this case – and the lawyer wrote Sue to tell her she did not have to pay the $2,000 bill.  The chiropractor got paid what Medicare owed and Sue owed nothing.  Way to go, Sue!

Here is the lesson to be learned:

Chiropractors do lots of things that are not covered by Medicare – and you probably want those tweaks and crunches and massages.  But you will pay for those services.  Make sure you know what you will have to pay and what Medicare will pay.

Here is a link to more info on Medicare coverage for chiropractor services:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Chiropractors_fact_sheet.pdf

Here is a highlight from that “fact sheet”:

If the beneficiary selects option #1, s/he is agreeing to pay out of pocket for the service in question and requests that the chiropractor file a claim for that service with Medicare. With option #1 selected, the beneficiary retains appeals rights if s/he disagrees with Medicare’s claim decision. The chiropractor is permitted to ask for payment from the beneficiary before the claim is filed if option #1 is chosen. (Beneficiaries who have secondary insurance may need a Medicare denial on a claim to enable reimbursement from their secondary insurance plan.)

Option #2: A beneficiary selects option #2 when s/he agrees to pay out of pocket for the service in question and does not want a claim sent to Medicare. In accordance with the ABN, the provider would not file a claim, and the beneficiary would not have appeal rights since no claim is being submitted. (Please note that the patient can change his/her mind at a future time and request the claim be submitted.)

Another billing example:

I have also written about another client, Sally, who ended up with a bill for a preventive screening test.  Sally signed an ABN and did not notice that it included a statement about how Medicare covers the service she received.  http://medicareblog.org/preventive-services-and-medicare/

 

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