DIRECT BILLING & INSURANCE
COMMON ISSUES

Most direct billing insurers require an additional completed consent form. If you would like the clinic to direct bill on your behalf, we require an additional completed form to process direct billing for policies that require it. This electronic form will be emailed to your account email address within 72 hours following your initial consultation from our Wondershare DocuSign service. Please monitor your spam folder during this period.

 

This direct billing authorization must be received and completed accurately within 48 hours of our office sending it. We will wait 48 hours after sending the Wondershare direct billing authorization to receive the completed form.

 

If you fail to return the form to use within 48 hours of our office issuing it, the credit card on file will be billed for the services delivered, and a receipt will be issued. If you fail to return the form within our 48-hour window, you will need to submit this directly to your insurer for reimbursement. 

 

For administrative reasons and costs associated with credit card fee returns, our office will not direct bill for services that have already been charged when forms are not returned within 48 hours of our office sending them. We appreciate your understanding and are happy to direct bill for future visits as soon as our office receives the completed forms.

 

Should your insurance details change, a new authorization will be required with the new policy details listed. Failure to provide the authorization forms or correct/updated information will result in your credit card being charged the full treatment value and an invoice issued. The patient will need to submit the invoice to their insurance for reimbursement. The clinic will not process direct billing for administrative reasons beyond 72 hours of a visit.

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Multiple plans. We cannot always direct bill both plans due to insurance policy-related processes outside our control. In such instances, an invoice will be provided so a patient may submit it to a secondary insurer for further reimbursement if the clinic cannot complete both on their behalf.

 

Insurance Fine Print - Policy Hidden Limits - Please Read Your Policy Fine Print

 

We often get the question, "I provided my insurance and have X $ amount of coverage; why did they not cover the whole visit, even though I have X% coverage, and why am I still being charged?"

 

Insurance policies can be complex, with fine print that can be difficult to navigate. These policies often advertise a certain percentage of coverage (e.g. 90%) and a total dollar value for the services they cover (e.g. chiro $500/year).

 

A policy worded like the one above leaves the policyholder assuming for a $200 initial consultation, their insurance will pay $180 for their visit. However, this is where the sneaky fine print in the policies comes into play. When we direct bill policies, our office is often provided with statements such as the following:

 

"You were reimbursed the maximum amount allowed based on reasonable and customary charges for this expense."

 

In your policy fine print, your insurance company arbitrarily decided on a maximum they would pay for any given visit type. These arbitrary numbers and percentages vary by company and policy. For example, a company may limit their per-service payment to $130 for an initial consultation and $50 for a follow-up consultation. These arbitrary limits are usually buried in the fine print of your policy. Using this example with a $200 initial consultation, the policyholder will still need to pay a $70 out-of-pocket expense, despite their policy stating there is a $500/year limit for chiropractic and offering them 90% coverage.

 

We understand our patient's frustration with this. Unfortunately, we have no way to check what a patient's coverage is. We encourage all patients to read the fine print of their policy and understand how their reimbursement might be limited by this sort of fine print prior to booking.

 

We will deal with frustrated patients in pain who then are faced with the added stress of interpreting the fine print of a misleading insurance policy advertising too often. If you feel your policy is an issue, please reach out to your insurer for clarification. Should they fail to address your concerns to your satisfaction, you could file a complaint with the insurance ombudsman of Alberta. The link is here:

 

https://www.alberta.ca/insurance-consumer-complaints

 

Should you decide to file a complaint with a consumer complaint, our office will support you in every way. We consider this sort of practice to be false advertising and unfair to patients in pain. These misleading policies cause increased administration costs and put patients offside when they feel our office has made a mistake in their direct billing.

 

If your policy has been limited, we don't feel this is your fault, nor do we see it as ours. We'd like to see the industry changed to align with the expectations most consumers have as they read the general terms of their policy.