At SoCal Spinal Decompression Center, Lee Chiropractic, Inc., we prioritize providing the highest quality of care tailored to each patient’s unique needs. One common question we encounter is why we do not accept insurance. This decision is rooted in our commitment to offering superior care that aligns with our wellness philosophy. Below, we explain our reasoning and provide a comprehensive Q&A section to address common concerns.

The Limitations of Insurance Coverage

1. Spinal Decompression CPT Code S9090

Spinal decompression therapy, a cornerstone of our treatment offerings, is represented by CPT code S9090. Unfortunately, this code is not covered by most, if not all, insurance companies. This lack of coverage can restrict patients from accessing this effective treatment without incurring out-of-pocket expenses.

2. Wellness, Maintenance, and Preventative Care

Insurance companies often focus on covering acute care—drugs, surgeries, and durable medical equipment like canes and wheelchairs. However, they are less likely to cover wellness care, maintenance care, or preventative care, which are crucial for long-term health and well-being. These types of care include regular chiropractic adjustments, nutritional counseling, and other holistic approaches that aim to prevent disease and maintain optimal health.

3. The Shift to Private Pay

Many healthcare providers, including MDs, functional medicine doctors, chiropractors (DCs), acupuncturists, naturopaths, nutritionists, and physical therapists (PTs), have chosen to adopt a private pay model. This shift allows them to offer higher-quality care without the limitations imposed by insurance companies. By not accepting insurance, providers can spend more time with each patient, create individualized treatment plans, and use the most effective therapies without worrying about insurance reimbursement.

Understanding Medicare Guidelines

Medicare’s guidelines further illustrate the challenges associated with insurance coverage for wellness and maintenance care. According to Medicare Guidelines, Section 2251.3:

“A treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition is deemed not medically necessary.”

Additionally, Medicare explicitly states that chiropractic maintenance therapy is not payable under its program. This includes services aimed at preventing disease, promoting health, prolonging life, or maintaining a chronic condition.

Comprehensive Q&A

Q1: Why doesn’t insurance cover spinal decompression therapy?

A: Spinal decompression therapy, represented by CPT code S9090, is not covered by most insurance companies. This therapy, while effective, falls under the category of treatments not deemed “medically necessary” by insurance standards, which typically prioritize acute and emergency care over wellness and preventative treatments.

Q2: What are the benefits of a private pay model?

A: A private pay model allows us to offer higher quality care without the constraints of insurance company policies. This means longer appointment times, personalized treatment plans, and the freedom to use the most effective therapies for each patient.

Q3: How do you ensure treatments are affordable without insurance?

A: We offer various payment plans and financing options to make our services accessible. Additionally, by eliminating the administrative costs associated with insurance billing, we can keep our prices competitive and transparent.

Q4: Why do other healthcare providers choose to go private pay?

A: Many providers find that insurance limitations hinder their ability to deliver the best possible care. By opting for a private pay model, they can focus on patient-centered care, offering treatments that might not be covered by insurance but are highly effective for maintaining health and preventing disease.

Q5: Can I still use my Health Savings Account (HSA) or Flexible Spending Account (FSA)?

A: Yes, many of our services can be paid for using HSA or FSA funds. These accounts allow you to use pre-tax dollars for eligible medical expenses, which can help offset the cost of treatments.

Conclusion

At SoCal Spinal Decompression Center, Lee Chiropractic, Inc., our decision not to accept insurance is driven by our commitment to providing the highest quality of care. By focusing on wellness, maintenance, and preventative treatments, we aim to enhance our patients’ quality of life in ways that insurance often does not support. We believe this approach leads to better outcomes and a healthier, happier community.

For more information or to schedule an appointment, please contact us at: SoCal Spinal Decompression Center, Lee Chiropractic, Inc. 1625 W. Olympic Blvd. Ste M103 Los Angeles, CA 90015 323-375-5147 www.socalbackdoctor.com Dr. Marvin Lee on LinkedIn