Here are the important things to know about getting the most out of your health insurance benefits:
1. You can choose between using the Honor Box or filing claims with your insurance. Unfortunately, you cannot do both at the same time. Many patients who have a chiropractic benefit on their policy, still decide to simply make payments to the Honor Box ignoring their insurance altogether because overall, they find it more convenient and less expensive.
2. We consider HMAA to be the best health insurance in Hawaii for chiropractic. For most of the HMAA policy holders, all that is required is a $5.00 copay each visit, and we’ll bill out the rest to HMAA. HMAA usually will cover 20-40 visits every calendar year.
3. If you have UHA insurance, our patients pay for their care up front (usually by purchasing a prepayment option). Every 4-5 weeks we will file a claim on your behalf to UHA for the visits you have had and paid for. UHA will then send you a reimbursement check in your name to your address. It usually takes about a month for UHA to process the claim. UHA will cover up to $500.00 a year.
4. HMSA is the largest health insurance in Hawaii and as you may expect, it is also the most confusing and most complicated when it comes to receiving your chiropractic benefits. Dr. Shiraki is a non-participating HMSA doctor. What that means is that like UHA members, patients with HMSA must pay for their visits up front and will receive reimbursement from HMSA directly. This is where it gets confusing. HMSA has many different plans, all with different chiropractic benefits attached. Most of the HMSA plans have no chiropractic benefit at all. For those that do have a plan with chiropractic benefits, the amounts covered vary greatly. Some plans will reimburse you only $10.00 per visit. Some may reimburse you a certain percentage back for 8 visits, then require a precertification for additional visits. The plans vary and are always changing. We highly encourage you to call HMSA customer service directly and find out exactly what your benefits are so that you may choose if it would be best to file for your benefits or simply use the Honor Box. Blue Cross Blue Shield and Cigna work just like HMSA.
5. Certain HMSA and Kaiser policies have an American Specialty Health chiropractic insurance rider. If you have ASH as an attached benefit to your policy, just cover the copay (varies between $10.00 - $25.00) and we’ll bill ASH for the rest. ASH will usually cover 5 -25 visits each calendar year, but this insurance company is notorious for denying claims they deem to be not a “medical necessity.”
6. Most of Hawaii Union benefits work like HMSA and UHA. Patients will pay up front and then receive reimbursement directly from their unions. If your union is covered under HWMG or HMAA, however, you only need to pay the $5.00 copay for your adjustment.
7. We do not accept Kaiser (without the ASH rider), Aetna, United Health Care. Hawaii’s Medicaid Quest programs (AlohaCare, Ohana Care) do not have chiropractic benefits. Also, TRICARE does not have any chiropractic benefit outside of the military health care system.
8. We also do not accept Medicare or any insurance plan that require Medicare participation like HMSA Akamai Advantage. We do have a very special Honor Box plan for our patients over 65 years of age.
9. We do accept Worker’s Compensation and No-Fault cases. Those patients filing claims for injuries from a car accident or while on-the-job pay nothing out-of-pocket. We will take care of all the paperwork and billing.