This patient has Medicare as primary, and Commercial insurance as secondary. We will show the Medicare benefits. We will show the Commercial Insurance benefits. We will show how the Commercial Insurance will coordinate with Medicare.

Medicare is Primary

• Co-pay for 98941 spinal manipulation - between $7.60 to $8.30 (The co-pay amount is different for each doctor each year).
• Exams/re-exams - Not covered by Medicare (but recommended to do on first visit of new diagnosis). Patient responsibility.
• X-rays - Not covered by Medicare. Patient responsibility.
• Therapies - Not covered by Medicare. Patient responsibility.
• Chiropractic Maximum - No chiropractic maximum per year, but has to be medically necessary. Medicare can do a records review if care goes on too long.
• Pre-authorization - Not required

• Deductible left to meet for this year - Patient pays clinic in full for charges. Medicare sends any payment to patient.
• Co-pay for 98941 spinal manipulation - Patient pays clinic in full for charges. Medicare sends payment to patient.
• Exams/re-exams - Not covered by Medicare (but recommended to do on first visit of new diagnosis). Patient responsibility.
• X-rays - Not covered by Medicare. Patient responsibility.
• Therapies - Not covered by Medicare. Patient responsibility.
• Chiropractic Maximum - No chiropractic maximum per year, but has to be medically necessary. Medicare can do a records review if care goes on too long.
• Pre-authorization - Not required

Commercial Insurance that is Secondary

In Network Benefits

Individual Deductible

Insurance Benefits

Spinal Manipulations - After Deductible is Met

Exams/re-exams - After Deductible is Met

X-rays - After Deductible is Met

Therapies - After Deductible is Met

Chiropractic Maximum

Pre-Authorization

Out of Network Benefits

Individual Deductible

Insurance Benefits

Spinal Manipulations - After Deductible is Met

Exams/re-exams - After Deductible is Met

X-rays - After Deductible is Met

Therapies - After Deductible is Met

Chiropractic Maximum

Pre-Authorization

Coordination of Benefits between the two insurances

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