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Insurance Co-Payment Limitations

Chiropractic physicians have experienced situations where their patient’s co-payment amount approaches or exceeds the entire charge for services rendered. The issue can be best attacked by two main points:

  • Some insurance providers incorrectly classify chiropractic physicians as “specialty health care providers,” which creates an even higher co-pay amount for the patient. Chiropractic care is not a specialty.
  • Insurance providers who sell policies that require these high co-pay amounts for chiropractic care are selling “phantom” insurance policies. Patients are paying excessively high co-pays in addition to premiums and receive no benefit from either.

The State of Missouri has passed a law similar to one that the ICS has proposed that prohibits the imposition of any co-payment that exceeds 50% of the total cost of providing any single chiropractic service. The Missouri law, though beneficial to the citizens of Missouri, has created a competitive disadvantage for chiropractic physicians in Illinois that practice along the Missouri/Illinois border.

To address this issue ICS introduced HB 693 (Martwick). The legislation limits the co-payment amount a health insurance carrier can charge a patient for health care services. The legislation prohibits The limit a health insurance carrier from charging more than 50% of the total cost of the services provided in a single visit. The ICS believes it is unfair to a patient to think they have chiropractic coverage through their health insurance plan and then pay large co-payments.

Due to strong insurance opposition, this legislation was unable to move this past session.