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  • Writer's pictureDr. Taylor Ferguson

Health Insurance and Chiropractic Care

Updated: Oct 18, 2023

As things are winding down before the crazy holiday season, it is important to not forget about your health insurance for the year ahead. Each year November 1st through December 15th is considered the “open enrollment” period. This is a time for you to explore different health insurance policies and make changes to your current policy. Be sure to set aside some time to research which plans are truly best for your family's needs and your upcoming health expenses. If you do not have the time to do the research, please contact a health insurance broker who can help you navigate all of the plans available to you, as well as their respective pros and cons.

How can you use your health insurance to cover your care at Function First Chiropractic:

As a private pay provider, why are we concerned about your health care choices? Despite not directly working with private insurance companies, there are two ways to get your chiropractic care, from our clinic, covered with your insurance benefits. We believe it is important to make you aware of this during this period of open enrollment. The first is through out-of-network benefits. If your plan has out-of-network benefits, they agree to reimburse you for out-of-pocket costs as a result of seeking care from providers who are out of your network. We can provide a specialized receipt, known as a superbill so that you are able to submit for reimbursement. When going about reimbursement in this way, you still pay upfront for the cost of care, at the time of service. You are then reimbursed directly from the insurance company after sending in your superbill. Typically most plans reimburse a certain percentage, some may even reimburse 100%. It all depends on the details of the plan that you select.

An additional way to have your care covered is by selecting a plan that offers a health savings account (HSA) or flexible spending account (FSA). HSAs are typically paired with a high deductible private insurance plan, meaning any individual can have access to an HSA with their private insurance. FSAs however, come as a benefit from your employer, meaning it is only accessible if your employer offers it as a part of their benefits package. Both HSAs and FSAs are ways to create nontaxable income as they are funded pre-tax. The biggest difference here is that your HSA is typically funded throughout the year and only has as much money as funds contributed at the time you go to use it. FSA’s are typically funded in full at the beginning of the year so that you can use your funds all year long. Additionally, with an HSA you can change your contribution amount at any point throughout the year, whereas with FSA you can only change your contribution amount at each open enrollment period. There are a few instances when you may be able to alter your FSA contribution outside of the open enrollment period, however, those situations are unique and uncommon. HSA’s allow funds to roll over or to be invested elsewhere, FSA’s typically must be used or forfeited at the end of each year. For more information on both of these options and which is right for you be sure to consult your accountant as well as a health insurance broker. When making decisions about your healthcare-related finances it’s important to consider your individual health needs or the needs of your family, not just the savings or expenses.

How to reduce the cost of care:

If you decide a lower deductible plan is best for your family and if your employer does not offer access to an FSA, remember we do offer “punch pass packages” to help reduce the cost of each individual appointment, saving you money in the long run. These packages are also eligible to be purchased with funds from either an HSA or an FSA as well.

Why is Function First Chiropractic out of network:

While we are on the topic of insurance, I thought it was important to share why I elected to be a private pay practitioner. The number one reason was so that I could spend more time with my patients and truly create meaningful change for each of them. When a chiropractor is in-network, it forces our hands towards creating a higher volume practice. This means I would need to see more patients every day and have to offer shorter appointment times in order to cover overhead and have a reasonable income. Secondly, most insurance companies only cover chiropractic adjustments from a chiropractor, no other modalities. My clinical experience and education have shown me how effective it is to combine adjustments with soft tissue treatment and corrective exercise. I would be forced to either only offer adjustments and therefore do a disservice to each patient or to charge patients for the services not covered by their insurance company, in addition to their co-pay. In most cases, this would essentially equal the cost of what you pay now for an appointment. Lastly, I believe that health insurance companies truly hold their finances in a higher priority than your health. When you work with a provider who is private pay, they are invested in your results and experience under their care. Good clinical results are good business. These providers rely on your reviews and referrals to build their practice, not an insurance company that has a plethora of potential patients to fill their schedule. All in all choosing a quality provider who has your unique medical history, needs, and health care goals top of mind is a better investment in yourself and your health.


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