Insurance Verification

How to verify if your insurance covers out-of- network chiropractic benefits: Well Connected Chiropractic is an out-of- network provider for chiropractic care. We do not accept HMO plans, covered California or Medical. We will bill your insurance if they cover out-of-network chiropractic care AND you have an individual deductible of $1,500 or less. When calling your insurance provider, ask them the questions below and fill out the form in detail. If you have questions about their answers and would like an explanation, bring the completed form to your first appointment and we can explain it to you in further detail

Full Name *

Phone *

How many chiropractic visits per year?

Is this a Multi-Plan account?

Is this a Calendar Year Plan?

Is this a Month to Month Plan?

Do I have out-of-network chiropractic benefits?

The information on this page is necessary for us to understand how your insurance covers your out-of-network chiropractic care. To determine if you have out- of- network chiropractic benefits, follow the steps below: Call your insurance provider with the number listed on your insurance card. You will need your insurance ID # and date of birth of the member. Ask them these questions:

If NO, then you do not have chiropractic coverage for an out-of-network provider. Please ask for the name of the representative and a call reference number and politely end the call. If YES, please move on to the next question.

Will my claims be sent through ASH (American Specialty Health)?

If YES, we CANNOT bill your insurance as ASH does not pay for chiropractic coverage. Please ask for the name of the representative and a call reference number and politely end the call. If NO, please move on to the next question.

What is my individual out-of-network deductible?

How much has been met already of my deductible?

If your deductible is more than $1,500, we will not bill your insurance. Please ask for the name of the representative and a call reference number and politely end the call. If your deductible is $1,500 or less, please move on to the next questions.

What is my family out-of-network deductible?

How much has been met?

What is the effective date of my insurance policy?

What is my individual out of pocket (OOP) maximum?

Family OOP max? How much has been met?

At what percent does my insurance cover?

Are x-rays covered?

Ask them to verify these CPT codes (this will tell us whether your insurance would cover different modalities that are used in the office) *

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