Insurance FAQ?

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  • Q: Do you accept insurance plans?
    A: We work with most PPO and HMO insurance plans. Currently we work with Anthem Blue Cross/ Blue Shield of Maine, Aetna, and Harvard Pilgrim Healthcare.
  • Q: I have an HMO, can I still be treated at your office?
    A: Yes absolutely. You do not need a referral to see one of our doctors. As primary care chiropractic physicians we are able to render a diagnosis and treat conditions within our scope of practice without the need for a referral.
  • Q: What if your office does not participate in my insurance network?
    A: We work with most insurance plans and some plans we are considered out-of-network providers. As a courtesy for patients wishing to use their insurance plan benefits, we can submit a claim to your insurance carrier on your behalf or provide a Superbill to send to your insurance carrier for direct reimbursement.

    In some cases, exact insurance benefits cannot be determined until the insurance company receives and processes the claim. If you have any questions, call the number on the back of your insurance card to learn more about your coverage. Ultimately it is your patient responsibility to verify benefits and understand your policy before a claim is sent by our office.
  • Q: What is a Superbill?
    A: A superbill is an itemized statement your doctor provides that includes the proper treatment and diagnosis codes your insurance company requires to process a claim for direct reimbursement to the patient.
  • Q: How much does a visit cost?
    A: Insurance policies may vary greatly in terms of deductible and percentage of coverage for chiropractic care.The amount that you owe depends on the specific health insurance plan you have. For patients with high deductible PPO plans and/or HSAs, you may prefer to pay for the visit out-of-pocket at an affordable cash rate.

    At the time of your treatment you pay for a portion of each office visit until your insurance company processes your claim. We bill your insurance provider for each visit, and you cover any portion of the unmet deductible, non covered services, or the allowed co-payment. Any overages will be credited to your account.

    As a courtesy our office staff would be more than happy to call and verify your benefits to determine your type of coverage free of charge. Please call our Scarborough Maine Chiropractic office at (207) 289-6005 and we will be glad to answer any questions.
  • Q: What is meant by Deductible?
    A: The deductible is the amount an individual must pay for health care expenses before insurance (or a self-insured company) covers the costs. Often, insurance plans are based on yearly deductible amounts. For instance, if your deductible is $2,000, you must pay that much out of pocket for covered health services before your insurance plan begins paying your health care costs. After that, they will pay their portion, or Co-insurance, for care you receive during that year, or until you have received all the benefits your policy provides.
  • Q: What is co-insurance?
    Coinsurance refers to money that an individual is required to pay for services, after a deductible has been paid. In some health care plans, co-insurance is called “copayment.” Coinsurance is often specified by a percentage. For example, if the total claim was for $100.00 and your coinsurance is 20%, then you would pay $20.00 toward the charges for a service and the insurance company pays the remaining 80%. Bear in mind you must meet any unmet deductibles amounts and coinsurance amounts in addition to your copay.

How Are You Different And What Can I Expect?

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  • Q: How are you different from other chiropractic offices?
    A: What set’s Mend Health and Wellness apart from other chiropractic providers is the various treatment modalities and extra training our doctors have pursued. Traditionally people think of chiropractors as manipulating the spine. Dr Tracey St John and Dr Victor St John both find great value in spinal manipulation, but it is just one of the many tools our doctors use to help get people better. Also at Mend you will notice our emphasis on muscle work and rehab concepts; in a typical appointment our doctors spend twice as much time performing muscle work as manipulation.
  • Q: What is your approach for each patient?
    A: We favor a hands-on approach in the treatment of musculoskeletal problems. While medications, electrical stimulation, ultrasound, etc. have their place; they do nothing to fix the issue, let alone its source. Most musculoskeletal problems follow a common pattern: pre-existing muscle imbalances (tight vs. weak,) causing joint dysfunction and further muscle irritation. Typically it is the joint dysfunction, muscle imbalance and muscle irritation that causes the pain, which therefore brings people in for treatment.

    However to truly solve most musculoskeletal problems you have to identify and correct the underlying factors that created the problem in the first place. At Mend Health and Wellness our approach is to incorporate the best treatments available for quick pain relief but also to put together the whole biomechanical puzzle as early as possible to start correcting these underlying factors which produce pain.
  • Q: What can I expect on my initial visit?
    A: The first treatment will typically last about one hour. We take a thorough medical history and conduct an examination. Afterwards we let you know what we’ve found, what the right course of treatment is for you, and how many visits it would likely take to resolve your problem. An average treatment plan is typically pretty short (i.e. 4-8 visits.) This often surprises patients. Our focus is truly on finding and fixing the source of your problem quickly, and giving you the tools and information to be pro-active in your recovery and injury prevention.

    We will always provide a treatment on the first visit if appropriate. Subsequent treatments are generally about one half hour. The half hour time slots we book are longer than normal for a typical chiropractic visit, but it is what our doctors feel are necessary to adequately get to the root of most people’s problems.
  • Q: What are typical treatment sessions like?
    A: It is difficult to say what a “typical” treatment is like. We customize many different approaches for the individual, the injury, and to any other factors affecting the injury. At Mend Health and Wellness of Maine we have a lot of different treatment options at our disposal, and our doctors use the most appropriate treatment on that day.

    Most treatments will include some amount of chiropractic manipulation and a fair amount of muscle work. The amount of each really depends on the problem. We also prescribe exercises as we progress through your treatment plan, preferring to give one or two rehab exercise at a time instead of over-whelming you with a bunch all at once.
  • Q: What type of clothing should I wear?
    A: Generally the only types of clothing that are problematic are dresses or skirts for woman or really tight fitting pants, other than that don’t worry too much about what you are wearing. If we are seeing you for a knee problem we will often give you a pair of athletic shorts to wear. Feel free to bring in your own. If we are seeing you for a shoulder problem it is sometimes helpful to wear a tank-top underneath your regular shirt.
  • Q: Once I start seeing a chiropractor will I need to keep coming indefinitely?
    A: Once the pain is gone, desired function has returned, and you are satisfied with your progress, we will discharge you from active care.
  • Q: Do you take X-rays of every patient?
    A: No. We only order X-rays if they are medically necessary to rule out fractures or pathology. On average X-rays are ordered on 10-20% of incoming patients.
  • Q: Does my chiropractor have to adjust my neck?
    A: At Mend Health we believe strongly in a patient centered approach to care and not a doctor centered approach to patient care. This means we do what is appropriate for each individual based on a patients well being, presentation of current symptoms, and any apprehension a patient may have towards the chiropractic spinal manipulation. Simply put, If you don't want to be adjusted you don't have to. We have many alternative treatment methods that will help treat your condition.
  • Q: What is that “cracking” noise that accompanies a chiropractic adjustment?
    A: An adjustment is usually targeted at a specific joint, causing that joint to rapidly gap open. When this happens a vacuum is temporarily formed within the joint, which then fills with gas from the surrounding area. When the joint closes back down the gas is released causing a “popping” sound. There is no pain associated with the noise. Most manipulation is relatively painless

How Are Soft Tissue Injuries Treated?

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  • Q: What is soft tissue?
    A: Soft tissue is anything other than bone. It includes muscle, tendon, ligaments, nerves, skin and the organs of the body. Our focus is on the soft tissues other than the organs, which is muscle, tendons, ligaments, and connective tissue.
  • Q: What Is Fascia?
    A soft connective tissue that wraps and connects the muscles, bones and nerves of the body. For various reasons, including disuse, not enough stretching, or injuries, the fascia and the underlying muscle tissue can become stuck together. This is called an adhesion or scar tissue, and it results in restricted movement along with pain, soreness and reduced flexibility or range of motion.
  • Q: What Is Scar Tissue And How Are Adhesions Formed?
    A: Our bodies contain special protein structures called collagen. Collagen forms a type of connective tissue called Fascia that interconnects all the components of your body, and acts as a flexible skeleton. When this tissue is healthy, it is smooth and slippery, allowing the muscles, nerves, blood vessels, and organs to move freely and function properly, but when tissues due to repetition fatigue, muscles tighten and the tissue becomes weak, brittle and less flexible.

    A tight muscle tends to weaken more, and a weak muscle tends to tighten more. As a result less blood, nutrients, and oxygen is received by the tissue. This will lead to decreased circulation and edema in the tissues and inflammatory agents will not be returned to lymphatic channels. This results in what’s called Cellular Hypoxia. From decreased circulation, it causes fibrosis and adhesions to occur between tissues. This continuous cumulative injury cycle is what forms the Adhesion. Fibrosis adhesions can occur as a result of acute injury, repetitive motion, and constant pressure or tension.

    A good way to picture what happens to the tissues when injured is to think of a paintbrush with the paint left in the bristles over night. All the bristles in the brush adhere or stick together and you no longer can use the brush. The body sticks the tissues together and creates scars in the tissues. Adhesions attach to muscles, decreasing their ability to work properly. You know you have an adhesion on a nerve if you get many abnormal sensations like numbness, tingling, or pain.
  • Q: What is Myofascial Release?
    A: Soft tissue mobilization is a manual method of treatment. The thumbs, fingers, hands and elbows of the provider may be used to apply pressure to the various muscles. This often occurs with the patient actively involved in some form of motion. The amount of pressure that is provided varies with the diagnosis, age of the patient, overall health of the patient, and consideration of the patient’s goals and the provider’s goals. The method of treatment performed at Mend Health & Wellness of Maine addresses all the soft tissues surrounding the involved joint or region.
  • Q: How Does Tissue Heal After An Injury?
    Once a soft tissue structure is injured, the body works to heal itself via a three-phase healing cascade. These three phases are inflammation, proliferation and maturation.

    In the inflammation (acute) phase, the body releases chemicals that start the healing process. The inflammatory phase is usually accompanied by pain and leads to immobilization of the injury site. You can usually see this first phase of healing as the skin around the injury site will look and feel swollen.

    During the proliferative phase, the body creates materials needed to create scar tissue at the site of the injury.

    During the maturation phase, scar tissue forms at the soft tissue injury site. Most of the time, you won’t be able to feel this scar tissue unless it is very superficial.

    This scar tissue is much less flexible than the normal tissue that was injured. This is because scar tissue forms in a relatively haphazard fashion which leads to it being rigid. As a result, it restricts movement which can lead to pain.
  • Q: How soon can soft tissue mobilization be performed after an injury?
    A: Soft tissue mobilization can usually be performed immediately after an injury. The acute nature of the injury is taken into consideration and the treatment is modified accordingly. This usually means that very light pressure is used. By addressing the soft tissues very carefully and with motion, we typically find that patients recover faster than those who delay in seeking care. There are certain injuries that require an intentional delay in providing treatment and these situations will be assessed on a case-by-base basis.