Cash-Pay · HSA · FSA · Out-of-Network Reimbursement
We don't bill insurance directly. You pay at the time of service. We give you an itemized superbill that you submit to your insurance for out-of-network reimbursement. Most PPO plans pay something. Some plans don't. Below: how to figure out which one you have.
A cash-pay practice means we don't have a contract with insurance companies. You pay us directly. We give you an itemized superbill at every visit. You submit the superbill to your insurance company for out-of-network reimbursement. The insurance company sends a check or direct deposit to you, not to us.
Three calls before your first visit
/01
"Does my plan cover out-of-network chiropractic care?" If the answer is no (common with HMO and EPO plans), the superbill won't produce reimbursement. You can still use HSA and FSA dollars for the visit, which is tax-advantaged.
/02
"What's my out-of-network chiropractic deductible and how much have I met?" Some plans have separate in-network and out-of-network deductibles. Track this to know when reimbursement actually starts.
/03
"Once I've met the deductible, what percentage does the plan reimburse for out-of-network chiropractic?" Many PPO plans reimburse 40 to 80 percent. Some less. The phone call takes 10 minutes and saves a lot of guesswork.
Superbill walkthrough
Provider information
Provider name (Dr. Joseph Krzemien, D.C.), NPI number, license number, clinic address, tax ID. Everything insurance needs to verify the provider.
Patient information
Patient name, date of birth, insurance information you provide. The patient submits this themselves to insurance.
Diagnosis codes (ICD-10)
The clinical diagnoses being treated. Insurance uses these to determine medical necessity. Examples: M51.26 (lumbar herniated disc), M54.5 (low back pain), M72.2 (plantar fasciitis).
Procedure codes (CPT)
The specific services delivered with units and charges. Examples: 98940 (chiropractic manipulation), 97140 (manual therapy), 97035 (laser therapy). Insurance uses these to determine the reimbursement amount.
FAQ
How does a cash-pay chiropractor work with insurance?
We don't bill insurance directly. You pay at the time of service using HSA, FSA, credit, debit, or cash. We provide an itemized superbill at every visit with the diagnosis codes, procedure codes, provider information, and amounts paid. You submit the superbill to your insurance company for out-of-network reimbursement on your own. Many PPO plans reimburse 40 to 80 percent of out-of-network chiropractic costs depending on the plan.
Can I use my HSA card?
Yes. Health Savings Account (HSA) cards are accepted directly at point of service. Chiropractic care is an IRS-qualified medical expense. Your receipt and our itemized superbill document the visit appropriately for HSA records and any audit purposes.
Can I use my FSA card?
Yes. Flexible Spending Account (FSA) cards are accepted directly at point of service. Same as HSA, chiropractic care is an IRS-qualified medical expense.
What is a superbill?
A superbill is an itemized receipt that includes everything an insurance company needs to process an out-of-network reimbursement claim: provider name, NPI, license, address, patient's name and date of birth, date of service, diagnosis codes (ICD-10), procedure codes (CPT), units and amounts billed, and the amount the patient paid. We provide a superbill at every visit.
How do I know what my insurance will reimburse?
Call your insurance company before your visit and ask three questions. One: Does my plan cover out-of-network chiropractic? Two: What's my out-of-network chiropractic deductible and how much have I met? Three: Once I've met the deductible, what percentage does the plan reimburse for out-of-network chiropractic? Most patients are surprised by the answer.
What about Medicare?
Medicare has specific rules about chiropractic that limit coverage to spinal manipulation for specific diagnoses, and the reimbursement rate is low. We don't bill Medicare. Medicare patients pay for visits directly using HSA, FSA, credit, or cash. We provide documentation that complies with Medicare's record requirements.
Why don't you take insurance?
Insurance reimbursement controls how much time a clinic can spend on you and which treatments get approved. We don't think that's how care should be decided. We're cash-pay so we can run 60-minute new-patient evaluations and build treatment plans around what your case actually needs.
Will my superbill count toward my deductible?
Usually yes for out-of-network deductibles. Some plans have separate in-network and out-of-network deductibles. Whatever you pay us that gets submitted via superbill typically counts toward the out-of-network deductible.
What if my insurance denies my claim?
The most common reasons are: the plan has an exclusion for chiropractic, the plan has no out-of-network benefit, the deductible hasn't been met, or a coding question on the superbill. The first three are about your plan and we can't change them. The fourth we can sometimes help with by adjusting the codes on the superbill if your insurance specifies what they need.
Call us before your first visit. We'll quote your specific case based on what you're coming in for. No commitment, no pressure, just the actual number.