Forms

GROUP OR INDIVIDUAL INSURANCE
Your insurance is an agreement between you and your insurance company, not between your insurance company and our office. We cannot be certain if your insurance covers Chiropractic, although most policies do provide coverage.  The amount they pay varies from one policy to another. When possible, we will call to verify benefits on your insurance; however, the benefits quoted to us by your insurance company are not a guarantee of payment. As a courtesy to you, our office will complete any necessary insurance forms at no additional charge, and file them with your insurance company to help you collect.  It is to be understood and agreed that any services rendered are charged to you directly and you are personally responsible for payment of any non-covered services, deductibles or co-pays.

PATIENTS WITHOUT INSURANCE
We offer a 20% discount on all services to those patients who do not carry insurance. We request that all first visit charges be paid at the time of your first visit.  On other visits, payment may be made each visit or at the beginning of the week.  We are happy to accept your cash, check, Master Card or Visa. Please note that this discount does not apply to supplements or products sold at Chiropractic Clinic of Iowa.

"ON THE JOB" INJURY (Worker’s Compensation)
If you are injured on the job, your care should be paid for under your employer’s Worker’s Compensation insurance.  You will need to inform your employer of the accident and obtain the name and address of the carrier of their insurance.  If your employer does not provide us with this information, if a settlement has not been made within 3 months, or if you suspend or terminate care, any fees and services are due immediately.

PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
Please present your auto insurance card, your health insurance card, and tell us if you have retained an attorney.  There are four options available to the PI patient:

• We will bill (accept assignment) from the Med Pay portion of your auto insurance. 
• We will accept a Letter of Protection or Doctor’s Lien from an attorney and await payment at the time of settlement as long as you remain an active patient.
• We will bill your standard health insurance plan and you will be responsible for all co-pays and deductibles as they are incurred.

Although you are ultimately responsible for your bill, we will wait for settlement of your claim for up to six months after your care is completed.  Once the claim is settled or if you suspend or terminate care, any fees for services are due immediately.

MEDICARE
We do accept assignment from Medicare.  The check is usually sent directly to our office in payment of the services that Medicare will cover which for Chiropractors is ONLY manual manipulation of the spine. Medicare pays 80% of the allowable fee once the deductible has been met.  You are required to pay the deductible and the remaining 20%. All other services we provide are NON-COVERED.  These services include, but are not limited to, x-rays, examinations, therapies, orthotics, supports, and/or nutritional supplements.  Medicare patients are fully responsible for charges of non-covered services.  Secondary insurance may or may not pay for these non-covered services.  Our office completes and files the forms for Medicare at no charge. 

SECONDARY INSURANCE
Please inform us of any secondary insurance you may have.  We will file secondary insurance for you in most cases.

MEDICAID (TITLE XIX)
We do accept assignment from Medicaid. The check is usually sent directly to our office in payment of the services that Medicaid will cover which for Chiropractors is ONLY manual manipulation of the spine and yearly x-rays. You are required to pay your co-pay should one apply. All other services we provide are NON-COVERED. Medicaid patients are fully responsible for charges of non-covered services.