Dr. David Warwick is a Preferred Provider for the following insurance companies.
If you don’t see yours on the list, give us a call — this list is being updated all the time, and we may be a preferred provider for your insurance after all!
- PIP (Personal Injury Protection) for all Auto Insurances
- Worker’s Compensation for WA State Dept of Labor & Industries, as well as all Self-Insured Work Comp Insurances
- Triwest / Veteran’s Choice Program
- Regence Blue Shield (including UMP / UMR for WA State employees and HMA)
- Premera Blue Cross
- Blue Cross / Blue Shield – Federal, National, and out of WA state plans
- Kaiser (PPO only, prior name – Group Health)
- First Choice Health Network
Some Popular Insurance Terms and What they Mean
So, here are some explanations regarding insurance for you.
When talking about insurance, you will see words like:
- MAXIMUM NUMBER OF VISITS
- PREAUTHORIZATION REQUIRED
- OUT OF POCKET MAXIMUM
- PREFERRED PROVIDER WRITE OFF
- HEALTH SAVINGS ACCOUNT (HSA)
- PRIMARY / SECONDARY INSURANCE
- MEDICARE / MEDICARE REPLACEMENT PLANS
But just what do all those words mean?
This is the amount you must pay to your healthcare providers before the insurance company will start to pay for any of your healthcare.
Deductibles renew every year, most often in January. This means most insurance plans follow a calendar year pattern, although some employers set up their company insurance plans to follow a fiscal year. So, you may have deductible in July instead of January!
Example: if you have a $500 deductible, you will pay your healthcare providers that $500 before your insurance will start to pay. It may be paid at one office, if you are only seeing one healthcare provider, or it may have to be paid at multiple offices, if you are seeing more than one healthcare provider. Either way, it won’t exceed $500 (in this example).
This is the amount you and your insurance company pay together, once your deductible is paid.
Example: you pay 20% of the bill while the insurance company pays 80% of the bill. Coinsurance ranges from 10% – 50% patient responsibility usually. Coinsurance is in addition to your yearly deductible.
Copays are the amount you pay each time you use your insurance. Copays are flat rates instead of percentages.
Example: you pay $10 each time you visit a healthcare provider. Copays may be different, depending on what type of healthcare provider that you see. It may be $10 at the Chiropractic office, but $50 at Urgent Care, for example.
Copays are smaller than deductibles, and they are paid on a per visit basis.
MAXIMUM NUMBER OF VISITS:
Maximum number of visits, in chiropractic offices, means the maximum number of times your insurance will pay each year for you to see Dr. Warwick and our other doctors for chiropractic care.
Some insurance plans have 10 visits per year allowed, others have 30, and some others are based on “medical necessity”. Medical necessity means that the insurance company, not your doctor, may decide at any time whether your care is necessary or not. Most doctors find medical necessity types of plans difficult to work with, as it can sometimes interferes with their recommended care for the patient. No matter what your maximum number of visits is for chiropractic care, know that we have many, many patients each year who switch back and forth from insurance to self-pay and back again to insurance when it renews. We are happy to work with you!
Preauthorization required means that your doctor needs to get preauthorization for your chiropractic care. We provide information regarding your specific care to the insurance company, and they decide how many chiropractic visits you will receive.
These types of plans can be confusing to patients, as the patient benefit booklet often says, for example, that 10 visits are allowed. However, after we submit the preauthorization documents, the insurance company may only approve 3 visits. Please note that this type of situation is completely out of our control, and we may only then provide you with the number of visits that has been approved, not the number that are possibly available.
No matter what your insurance company authorizes for a maximum number of chiropractic visits, know that we are happy to work with you. Many of our patients start out as preauthorization required insurance visits, and then switch to self-pay.
OUT OF POCKET MAXIMUM:
Out of pocket maximum is the maximum amount you will pay to your healthcare providers, usually in one year. Once you meet this out of pocket maximum, the insurance will start paying at 100%. This usually is for patients who had expensive surgeries or other expensive healthcare procedures, all in one calendar year. Once you have met your OOP (out of pocket maximum), then you will not owe any additional copayments or coinsurance amounts for the remainder of the year.
PREFERRED PROVIDER WRITE OFF:
PPO write off (preferred provider write off) is the dollar amount that our office writes off, or deducts, from your bill, as Dr. Warwick and our other healthcare providers are part of an insurance company’s preferred provider network.
$200 total bill
$20 PPO write off
$180 new bill
$18 due from the patient for coinsurance at 10%
$162 due from the insurance company for 90% of the bill after PPO write off
HEALTH SAVINGS ACCOUNT (HSA):
Some of our patients have health savings accounts from which they pay their healthcare bills. These are special savings accounts that can be used only for health care costs. Many patients have separate HSA cards and / or checks that can be used directly to pay our office.
PRIMARY / SECONDARY INSURANCE:
Most of our patients with insurance have primary insurance. Primary insurance means that you have one insurance plan that will help to pay for your healthcare costs. Some of our patients also have secondary insurance. This most often happens when two spouses are working, and they decide to be covered under both of their insurance plans. It also can happen with our Medicare patients, when Medicare is primary insurance and then another insurance plan is secondary insurance.
MEDICARE / MEDICARE REPLACEMENT PLANS:
Many of our senior patients have Medicare as their primary insurance, and some have Medicare as primary and another insurance company as secondary. However, a newer – and sometimes confusing – option for our seniors, is to bypass Medicare as their primay insurance, instead choosing what is called a Medicare Replacement Plan. This is essentially an insurance plan by a company other than Medicare, that is replacing Medicare. Ask any of our office staff for a referral to an insurance agent who specializes in health insurance choices for seniors – we would be happy to share that information!
As you can see, insurance topics and vocabulary are varied and many times confusing. There is no way our short video can explain it all! If you would like to verify your insurance coverage prior to care or any time during your care, you can use our Insurance Verification form, which is found on our website, under the Forms tab. Know that we are here to help you navigate the variables that insurance can bring, and also know that we always have self-pay options for those without insurance or who have maxed their insurance for the year.
Please ask any of our staff if you have any questions!