How to see a Chiropractic Doctor with the least amount of out-of-pocket payment.

Personal Injury and Third-Party Auto Claims

Do you bill the at-fault driver’s insurance company directly?

Every automobile-accident claim is different. In many cases, the at-fault insurance carrier will not pay medical providers while the claim is still being investigated or negotiated.

Our billing coordinator will review your available payment options, which may include:

• Medical Payments coverage through your own automobile policy

• Health insurance, when appropriate

• An attorney’s Letter of Protection or medical lien

• Direct payment or another agreed-upon arrangement

When appropriate, we provide itemized bills, clinical records, and supporting documentation to your attorney or the responsible insurance carrier. You remain financially responsible for your care unless and until payment is received from another source.

Do you accept and bill Medical Payments coverage—MedPay—from my automobile policy?

MedPay may be available through your own automobile insurance policy, regardless of who caused the collision. If you have MedPay coverage, please provide us with your automobile insurance information, claim number, adjuster’s contact information, and the amount of coverage available.

Our billing staff can determine whether your MedPay benefits can be billed for the services you receive. Coverage and payment are subject to the terms and limits of your individual policy.

Ohio generally does not use a traditional no-fault PIP system, but policies issued in other states may include PIP benefits. We will review the coverage that applies to your particular claim.

Do you accept a Letter of Protection or medical lien?

We may accept a Letter of Protection or medical lien when a patient is represented by a personal-injury attorney. Acceptance is determined individually and requires the appropriate written agreement.

A Letter of Protection allows the office to defer collection of an outstanding balance while the claim is pending. It is not health insurance, and neither the attorney nor the insurance company guarantees payment. The patient remains responsible for the bill if the claim does not produce enough money—or any money—to pay the balance.

Certain outside providers, such as an MRI facility, may require a separate Letter of Protection signed by the attorney before scheduling services.

Who coordinates billing and records with my attorney or insurance adjuster?

Our billing and records staff coordinate requests for itemized bills, treatment records and other authorized documentation. Dr. Sheely communicates clinical findings, diagnostic information and treatment recommendations when professional involvement is needed.

To help us respond promptly, please provide:

• Your attorney’s name and contact information

• Your automobile insurance claim number

• Your adjuster’s name, telephone number and email

• Your MedPay coverage information

• A copy of the accident report, when available

• Information concerning emergency-room, hospital and other medical treatment

We require a properly signed authorization before releasing protected medical information.

Major Medical and Health Insurance

Are you an in-network provider with my health-insurance plan?

Insurance participation varies by insurance company and by the specific plan within that company. Having an insurance card with a familiar company name does not necessarily mean that every plan uses the same provider network.

Please call our office at 513-217-7035 and give us the exact information from your insurance card. We will tell you whether the office participates with your particular plan or whether out-of-network or self-pay options may be available.

Patients with UnitedHealthcare should contact us before scheduling because our office is no longer participating with many UnitedHealthcare plans.

Can you verify my chiropractic benefits before my first appointment?

Yes. When possible, our staff can contact your insurance company to obtain an estimate of your chiropractic benefits, including:

• Deductible status

• Copayment or coinsurance

• Number of covered visits

• Referral or prior-authorization requirements

• Coverage limitations for examinations, adjustments and therapies

Benefit verification is not a guarantee of payment. The insurance company makes the final coverage determination after it receives and processes the claim.

Does health insurance cover everything performed during the initial evaluation or treatment?

Not necessarily. Coverage depends on your plan, medical necessity, deductibles, visit limitations, and exclusions.

A plan may cover an examination, chiropractic adjustment or certain rehabilitative procedures while excluding or limiting services such as:

• Massage therapy

• Dry needling

• Spinal decompression or traction

• Cold-laser or red-light therapy

• Specialized imaging analysis

• Nutritional or wellness services

Before beginning a service that may not be covered, we will explain the anticipated charge and your available options whenever reasonably possible.

Will I need a referral or prior authorization?

Many insurance plans allow patients to see a chiropractic physician without a referral. However, some employer plans, managed-care plans and government-sponsored programs may require a primary-care referral, authorization or additional documentation.

Our staff can help you determine whether your plan has these requirements, but the patient is ultimately responsible for complying with the rules of the insurance policy.

Out-of-Pocket and Self-Pay Costs

What is the cost of my first visit if insurance does not apply?

We offer a no-cost consultation so that you can discuss your condition and determine whether an examination is appropriate.

If you decide to proceed, the usual maximum self-pay charge for the consultation and comprehensive initial examination is approximately $125. Imaging, treatment, specialized testing or outside diagnostic services are not automatically included in that amount. We will explain any recommended additional charges before they are performed.

What is the usual cash price for a routine visit?

A typical self-pay chiropractic visit is generally:

• $65 for treatment involving one or two spinal regions

• $75 for treatment involving three or four spinal regions

Additional therapies or procedures may be billed separately. The exact cost depends on what is clinically necessary and what is performed during the visit.

Do you offer payment plans or discounted care programs?

Yes. When a longer course of care is recommended, eligible patients may be offered structured payment options. Depending on the plan, available courtesy discounts may include:

• 20% when an eligible care plan is paid in full

• 15% with two payments

• 10% with three payments

• 5% with four payments

Not every service qualifies for a discount. Massage therapy, dry needling, red-light therapy and certain outside or noncovered services may be excluded. Any payment arrangement will be explained in writing before you make a decision.

Documentation and Personal-Injury Evidence

Do you provide comprehensive narrative reports and causation documentation?

Yes. Dr. Robert Sheely has extensive postgraduate training in spinal trauma, MRI interpretation, ligament injury, spinal biomechanics, AOMSI and personal-injury documentation.

When clinically and legally appropriate, the office can provide detailed documentation that may include:

• The history and mechanism of the collision

• The relationship between the mechanism and the diagnosed injuries

• Orthopedic and neurological examination findings

• Digitally measured range of motion

• Strength, sensory and functional findings

• Validated disability and outcome questionnaires

• Imaging findings and biomechanical analysis

• Treatment provided and the patient’s response

• Progress demonstrated during re-examinations

• Activity, work, sleep and recreational limitations

• Prognosis, maximum medical improvement and future-care considerations

• A professional causation opinion when supported by the available evidence

Reports and opinions are based on the history, examination, diagnostic evidence and records available in the individual case. We cannot guarantee that every symptom will be attributed to the collision or that every case will contain evidence of permanent injury.

Do you perform slice-by-slice MRI reviews and biomechanical injury analysis?

When an MRI is clinically indicated, Dr. Sheely may request specialized imaging protocols designed to obtain the slices and views needed to evaluate suspected spinal injury more completely. 

The MRI is interpreted by a qualified radiologist or neuroradiologist. Dr. Sheely may also perform a clinical overread, correlate the images with the patient’s examination and symptoms, and evaluate whether additional biomechanical analysis is appropriate.

• Specialized MRI protocol, radiologist interpretation, clinical image overread, and biomechanical correlation when supported by the evidence.-  

  
  

Depending on the evidence, the evaluation may address:

• Disc protrusions, herniations, or annular injury

• Spinal canal or neural-foraminal narrowing

• Nerve-root or spinal-cord involvement

• Ligament injury

• Altered segmental motion

• Translational or angular instability

• Alteration of Motion Segment Integrity—AOMSI

• Whether imaging findings are consistent with the reported mechanism and clinical findings

  
  

Flexion-and-extension radiographs and MRI examinations answer different questions. MRI is particularly useful for discs, ligaments, nerves and other soft tissues, while properly performed flexion-and-extension studies may help measure abnormal intersegmental motion.

Not every collision produces a measurable disc, ligament or instability finding. Any conclusion must be supported by the actual images, objective examination findings and accepted clinical methodology.

Will you communicate with my attorney?

With your written authorization, our office can provide your attorney with appropriate records, itemized billing, imaging reports, examination findings, progress reports and final documentation.

Dr. Sheely may also explain the clinical and biomechanical significance of the findings. The office provides medical and chiropractic opinions—not legal advice—and does not determine what a claim is worth or guarantee a settlement result.

For qualified cases, expert testimony may also be available by separate arrangement.

Let Us Review Your Options

You do not have to understand every insurance or legal issue before scheduling an evaluation. Bring your health-insurance card, automobile insurance information, claim number, attorney information, and any available hospital or imaging records.

Call Middletown Spine and Injury – Sheely Chiropractic at 513-217-7035. We will review the available information and explain the next appropriate step.