Chiropractic care is one benefit that members get as part of their health plan through Health New England. Because the chiropractic claims process is slightly different from the medical claims process, we would like to help clarify the differences for you and your clients.

Currently, all chiropractic claims are processed by OptumHealth Care Solutions, a vendor contracted by Health New England. Members who get chiropractic care receive an Explanation of Benefit (EOB) directly from OptumHealth Care Solutions for claims where deductible or coinsurance is affected.

This EOB includes the following information, when applicable:

• Amount applied to the  member’s deductible
• Copay and coinsurance for service(s)
• Member’s responsibility (deductible + copay + coinsurance)

Deductible and Out-of-Pocket Maximums
Chiropractic claims are reflected in a member’s deductible (the amount a member must pay before the plan begins to pay) and in the maximum out-of-pocket totals (total amount a member will have to pay during a policy period).

Members should be aware that deductibles and maximum out-of-pocket totals reflected on the EOB and on the member portal at my.healthnewengland.org are based on information at point-in-time and may not reflect all outstanding claims.

Please note: Chiropractic claims do not currently display on the “Claims” detail screen on the member portal even though the deductible and maximum out-of-pocket figures displayed do reflect those amounts.

HealthEquity Reimbursements for Chiropractic Claims

• Members enrolled in a Health Savings Account (HSA) through HealthEquity can submit a copy of their EOB for reimbursement to HealthEquity by logging into the HealthEquity portal directly, via their Health New England member portal account, or by completing and mailing the HSA Reimbursement Form.  Additional information can be found at http://learn.healthequity.com/sample-hsa/hsamemberguide/member-portal.

• Members enrolled in a Flexible Spending Account (FSA) or Health Reimbursement Account (HRA)* can submit a copy of their EOB for reimbursement to HealthEquity by logging into the HealthEquity portal directly, via their Health New England member portal account, or by completing and mailing the FSA and HRA Reimbursement Form.  Additional information about FSA can be found at http://learn.healthequity.com/sample-fsa/fsamemberguide/member-portal and about HRA at http://www.healthequity.com/learn/health-reimbursement-arrangements.

For any questions or assistance with their claims, members should contact Health New England Member Services at (800) 310-2835, Monday – Friday, 8:00 a.m. – 6:00 p.m.

*For HRAs that are part of employer-sponsored plans, members enrolled in a high deductible health plan (HDHP) should verify qualified eligible expenses with their employer. HRA claim reimbursement requests made to HealthEquity are limited to Chiropractic Services only.