HOW DOES MY INSURANCE WORK?

Celebrate Wellness!A public service of

The Unified Virginia Chiropractic Association

in association with A Trusted Voice

Presented by:

Your Doctor of Chiropractic

Underwritten in part by a generous donation from:

How Does My Insurance Work?

Today’s Agenda:• Health (sickness/injury) insurance: History• Key Terms• Facts & Tips• Self-care and living WELL

How Does My Insurance Work?

Today’s Agenda:• Health (sickness/injury) insurance: History• Key Terms• Facts & Tips• Self-care and living WELL

The Year: 1940

The Year: 1955

1940 19550

10

20

30

40

50

60

70

80

Health Insurance Coverage

Health Insurance Coverage

The Year: 1960

Part A: Hospital Insurance

Part B: Hospital Insurance

“Maintenance therapy is defined as a treatment planthat seeks to prevent disease, promote health, andProlong and enhance the quality of life; or therapy that isperformed to maintain or prevent deterioration ofa chronic condition.”

“Maintenance care [sometimes called “Wellness Care”] is not considered by Medicare to be medically reasonable and necessary, and is not reimbursable by Medicare.”

Part C: Medicare Advantage (?)

Part D: Rx Drug Coverage

1970’s, 1980’s, 1990’s…

H.M.O. P.P.O.

P.O.S.

The Year: 1996

The Year: 2010

The Affordable Care Act,AKA “Obamacare”

The Future

How Does My Insurance Work?

Today’s Agenda:• Health (sickness/injury) insurance: History• Key Terms• Facts & Tips• Self-care and living WELL

Acute Subluxation (per Medicare Necessity for Treatment)Advance Beneficiary Notice (ABN)Affordable Care ActAllowable ChargeAuthorizationDeductibleChronic Subluxation (as per Medicare Necessity for Treatment)Co-insuranceCo-payCovered Medical ExpenseCovered ServicesEOBInvestigative Procedures or MedicationsMaintenance TherapyMedical NecessityNetworkNon-par (Non-Participating Provider)Par (Participating Provider)Pre-AuthorizationPre-CertificationPreventive CareUtilization ManagementUtilization reviewWellness Program

And more! Visit http://bit.ly/1qL7a74for a more comprehensive on-line “dictionary”

How Does My Insurance Work?

Today’s Agenda:• Health (sickness/injury) insurance: History• Key Terms• Facts & Tips• Self-care and living WELL

Does health insurance guarantee good health?

Insurance

Health

Medicare

Quality

How Does My Insurance Work?

Today’s Agenda:• Health (sickness/injury) insurance: History• Key Terms• Facts & Tips• Self-care and living WELL

Celebrate WELLNESS!

Case Studies

Resources

• Unified Virginia Chiropractic Associationhttp://virginiachiropractic.org/

• Or just ask the doctor today!

QUESTIONS?