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Questions for Insurance Coverage


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Insurance Questionnaire

Will your chiropractic or massage visit be covered by your insurance?

  • ***Brown Family Chiropractic cannot guarantee your benefits and coverage.
  • ***Your level of benefit coverage is a contract between you and your insurance company.
  • *** It is your responsibility to verify and make not of all visits, restrictions, and limitations.


To help you in ensuring you obtain accurate insurance coverage information, here are some suggested questions and information to assist you when calling your insurance providers.

  1. What is the name of the person you are speaking to about your coverage: __________________________________
  2. Date you call: __________________________________
  3. When calling, ask for “Chiropractic Benefits”
    • Is Dr. Sally Brown at Brown Family Chiropractic; 4401 Taylor Ave #103, Racine, WI 53405
      1. In Network? __________________________________
      2. Out of Network? __________________________________
  4. Do you have a copay?  __________________________________
  5. How many visits are covered for chiropractic care?  __________________________________
    1. Limit on number of visits?  __________________________________
    2. Limit on dollar amount covered?   __________________________________
  6. Are you covered for “neuromuscular re-education” and/or “myofascial release” (massage)?
    1. “Massage” Codes to Verify:
      1. 97112:  __________________________________
      2. 97140:  __________________________________
      3. 97124:  __________________________________
    2. Acupuncture Codes to Verify: 97810:  __________________________________
    3. Is there a limitation on a number of visits for neuromuscular re-education/units?  __________________________________
    4. Is there a dollar amount limitation for visits/units?  __________________________________
    5. Does the insurance count a neuromuscular re-education visit as a separate visit from the chiropractic adjustment?  __________________________________
    6. Does the insurance allow the adjustment and the neuromuscular re-education visits to be on the same day?  __________________________________


Please return this questionnaire on your next visit and be sure to call and update if there is any change in your insurance coverage.


Click here to Download a Copy to Print.

Disclaimer: The entire contents of this website are based upon the opinions of Brown Family Chiropractic, unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. We do not recommend any dosages until the patient has been evaluated by our doctors. It is intended as a sharing of knowledge and information from the research and experience of the doctors at Brown Family Chiropractic and their community. Dr. Brown & Dr. Pfarr encourage you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. If you are pregnant, nursing, taking medication, or have a medical condition, consult your health care professional before using products based on this content.

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