Insurance and Payment Options

Insurance Plans We Work With

Fisher Chiropractic Irvine is an out-of-network provider. We work with many PPO plans that include out-of-network chiropractic benefits.

We may also accept or assist with:

• PPO plans with out-of-network benefits
• HSA and FSA payments
• Automobile medical-payments coverage, commonly called Med-Pay
• Approved automobile-insurance claims
• Authorized workers’ compensation cases
• Patient reimbursement claims and superbills

Coverage is always subject to the individual policy, eligibility, authorization requirements and the medical necessity of the services provided.

Plans We Are Generally Unable to Accept

At this time, we are generally unable to accept or directly bill the following programs:

• Medicare
• Medi-Cal
• CalOptima
• Cigna
• American Specialty Health, commonly called ASH
• Many plans purchased through Covered California

Covered California is an insurance marketplace rather than a single insurance company. Benefits vary among the plans sold through it. Many of these plans have limited or no out-of-network chiropractic coverage, but we will review your particular plan whenever possible.

Insurance participation policies can change. Please contact our office before scheduling so we can review your current coverage.

What We Need Before Your First Visit

Please provide the following before your appointment:

• A clear copy of the front and back of your insurance card
• Your full name and date of birth
• The policyholder’s name and date of birth, if different
• Your insurance identification and group numbers
• Any referral or authorization information provided by your plan
• Automobile-insurance or workers’ compensation information, when applicable

Whenever possible, our staff will contact your insurance company before your first visit to obtain an estimate of your benefits.

Verification Is Not a Guarantee of Payment

An insurance verification is only an estimate based on the information provided by the insurance company at that time. It is not a guarantee that the plan will pay a particular claim or a specific amount.

The final determination may depend upon:

• Whether your policy was active on the date of service
• Your remaining deductible
• Copayments or coinsurance
• Out-of-network benefits
• Visit or dollar limitations
• Prior-authorization requirements
• The insurance company’s allowed amount
• Medical-necessity requirements
• How the insurance company processes the submitted procedure and diagnosis codes

Sometimes we cannot determine the actual reimbursement until the insurance company processes the first claim and issues an Explanation of Benefits.

Payment May Be Sent to You

Because we are an out-of-network provider, some insurance companies may send reimbursement directly to the patient rather than to our office.

If your insurer sends you payment for services provided by Fisher Chiropractic Irvine, that payment may be owed to our office under your financial agreement or assignment-of-benefits authorization. Our staff will explain this process before treatment begins.

When direct billing is not available, we may provide an itemized superbill or other claim documentation so that you can request reimbursement under your plan’s out-of-network benefits.

American Specialty Health and ASH-Managed Benefits

Some insurance companies delegate their chiropractic benefits to American Specialty Health. These plans may impose separate authorization, provider-network, visit and reimbursement requirements.

Fisher Chiropractic Irvine does not currently participate with ASH. If your chiropractic benefits are administered by ASH, our staff will explain whether you have another reimbursement option or whether self-payment would be required.

We will not know the exact benefits until we review your individual plan.

HSA and FSA Payments

We accept eligible Health Savings Account and Flexible Spending Account payments. Eligibility depends upon the applicable tax rules and the terms of your account. Patients should retain their receipts and consult their plan administrator or tax professional when necessary.

Automobile Injuries and Med-Pay

We may accept automobile medical-payments coverage when it is available and properly authorized. We may also work with approved automobile-injury claims under appropriate financial arrangements.

Coverage depends upon the policy, available limits, claim status and required documentation. Please provide the insurance carrier, claim number, adjuster’s name and contact information before your appointment.

Workers’ Compensation

We accept certain authorized workers’ compensation cases. Written authorization or confirmation from the appropriate claims administrator may be required before treatment begins.

Please provide the employer, insurance carrier, claim number, adjuster and any authorization or medical-provider-network information available to you.

If Your Insurance Does Not Cover Your Care

A lack of insurance coverage does not necessarily mean that care is unaffordable.

We offer self-pay options, prepaid care arrangements and payment plans for eligible patients and services. These options are discussed only after Dr. Fisher has examined you and determined what care, if any, is clinically appropriate.

Treatment recommendations cannot be responsibly made before an examination. Every patient and condition is different, and your care will be individualized according to your examination findings, imaging when clinically appropriate, functional limitations and response to treatment.

Self-pay packages generally apply when insurance is not being billed or when services are not covered under the patient’s plan. All insurance claims and patient payments must be reported accurately.

Estimates and Financial Transparency

We will make a good-faith effort to estimate your expected financial responsibility before treatment begins. Estimates are based on the information reasonably available at the time and may change if:

• Your insurance company provides inaccurate or incomplete information
• Your deductible or benefits have changed
• Your condition requires different services than originally anticipated
• The insurer changes its coverage determination
• A service is denied or determined not medically necessary

Uninsured and self-pay patients may request a written good-faith estimate of expected charges in accordance with applicable law.