Insurance & payment, explained

The short answer

Action Wellness is in-network with Blue Cross/Anthem, works with Medicare and some Medicare Advantage plans, and can provide itemized bills for patients who submit claims themselves. Participation and benefits must be verified for your exact plan, clinician and service.

Blue Cross / Anthem

Bring your current card and ask the office to verify the exact product and network. Employer plans, marketplace products, HMO and PPO options can have different rules, even under the same brand. A provider may participate in one network and not another.

Ask about your remaining deductible, copay or coinsurance, visit limits, referral or prior-authorization requirements and whether the proposed service is a covered benefit. If a plan administrator gives you information, record the date and reference number.

Original Medicare

Medicare Part B has a narrow chiropractic benefit for eligible spinal manipulation to correct a subluxation when coverage requirements are met. It is not comprehensive coverage for every service offered at a chiropractic office. Maintenance or wellness care is not covered under this benefit.

Medicare does not cover other services or tests ordered by a chiropractor, including X-rays and massage therapy. Do not assume decompression, rehabilitative exercise, cold laser or hormone testing will be covered because a spinal manipulation benefit exists. Ask about each item and any required noncoverage notice before treatment.

After the Part B deductible, Medicare.gov lists a patient share of 20% of the Medicare-approved amount for covered chiropractic services. Your circumstances and other insurance can affect what you pay. Ask the office about assignment and your estimated responsibility.

Medicare Advantage

We work with some Medicare Advantage plans. These plans have their own provider networks, benefit designs and authorization rules. Confirm the full plan name and whether the clinician is in-network for that specific product. An extra benefit advertised by a plan does not automatically apply to every service or every provider.

Itemized bills for self-submission

If you are submitting your own claim, ask for an itemized bill and your insurer’s claim instructions. The insurer may require patient and provider information, dates of service, service and diagnosis codes, charges and proof of payment. Submit sensitive health information only through the insurer’s designated secure process.

An itemized bill documents services; it does not create coverage, satisfy every plan rule or guarantee reimbursement. Out-of-network deductibles, exclusions, filing deadlines and reimbursement limits may apply. The insurer makes the claim decision.

Before your first visit

• Have your insurance card and member details available when speaking with the office.
• Verify the exact clinician, network and proposed services with both the office and your plan.
• Ask for estimated out-of-pocket costs, including noncovered services and testing.
• Clarify whether a referral or authorization is needed before care begins.
• Ask about self-pay costs if you are uninsured or choose not to use insurance.

Costs should be a conversation

We do not publish unverified prices or promise that a plan will pay. Call (309) 662-8418 to discuss the services you are considering. If you are uninsured or self-pay, ask about a Good Faith Estimate and visit the practice’s existing Good Faith Estimate information.

Common insurance questions