balanced body integraded wellness and studio
2569 W. Fullerton Ave. Chicago, IL 60647 ph: 773-252-9740 fax: 773-252-9746
www.balancedbodywellness.net
medical insurance and benefits
This page was created to serve as a reference for understanding your insurance benefits. Dr. Kim has been credentialed as preferred providers for the following insurance companies:
• Aetna US Healthcare
• Blue Cross and Blue Shield of Illinois
• Blue Cross and Blue Shield of Illinois HMO through Advocate Health Care
• Cigna Health Care
• Humana
• UnitedHealthCare
• PHCS
We also bill to:
• Medicare
• GreatWest Health
• Personal Injury Protection (PIP)
• Labor & Industries - IL (L&I)
Help Me Understand My insurance Benefits
Click on one of the following links to read an explanation about the term and gain helpful advice in gathering information about your benefits:
Deductible: The initial amount that must be paid out-of-pocket before insurance kicks in. Back to list.
Co-Pay: An out-of-pocket fee to be paid to your service provider at the time of each service. Back to list.
Coinsurance: After a deductible has been met, there is a coinsurance percentage. This number tells you what percent of the service your insurance company will pay for (up to an allowable amount). Many insurance plans will cover 100% after you've received a certain dollar amount in services (this is called a stop loss). Back to list.
Allowable amount: This is a predetermined amount that your insurance is willing to pay for any given service. Some insurance companies that claim to cover 100% of a service, will only do so up to an allowable amount. That amount could be lesser than the cost of the service, therefore still leaving you with out-of-pocket expenses. We encourage you to research allowable amounts when choosing insurance plans and health care providers. Things aren't always as they seem. Back to list.
Out-of-pocket expenses: This is a general term for anything left unpaid by your insurance company, including: deductibles, co-pay, and coinsurance. Back to list.
Preferred Provider: This is what insurance calls their contracted providers. In order to become a preferred provider, health care practitioners must fill out an application and go through a rigorous screening process. Back to list.
In-Network: This is another term for a preferred provider, meaning that the given provider is working in that insurance company's network. Back to list.
Out-of-Network: This is a term for practitioners who are not preferred providers, or rather who have not been contracted your insurance company. Many insurance companies allow for their members to receive treatment from out-of-network providers under certain plans. Back to list.
Explanation of Benefits (EOB): Whenever your provider bills your insurance company for a service, your insurance company will send you an explanation of benefits. This paper briefly explains what has been billed and how much was or was not covered and why. Back to list.
PIP and L&I
In addition to insurance, we also bill for Personal Injury Protection (PIP) claims and Labor and Industries (L&I) claims. The process for these are a little bit different, but, again, we'll do all of the researching and billing for you. With a PIP and L&I claim, you'll have an adjustor assigned to your case. The adjustor is the person in charge of managing your claim, and whom we'll work with directly in order to make sure you get the paid treatment that you need. Most PIP and L&I claims will remain open until you've reached the dollar limit for treatment, you are no longer affected by your injuries, or your claim becomes dated. Back to list.
If you're unsure of your insurance coverage, let us help you figure it out. Our staffs will contact your insurance company to inquire about your plan's chiropractic benefits prior to your first visit. When determining your coverage, here are some important questions that we ask your insurance company:
- Is Chiropractic covered by this plan?
- Is pre-authorization required?
- Is there a deductible? If yes, what is the deductible? How much has been met?
- Is there a maximum yearly benefit for Chiropractic? Number of visits? Specific dollar amount?
- What percentage is covered?
- Does my plan cover custom made orthotics ?
- Are benefits for other forms of health care taken from the same pool as chiropractic, such as physical therapy, massage and acupuncture?
Contact Balanced Body, with any questions at (773) 252.9740.
