MEDICARE WAIVER FORM: 2026
  • Robichaud Chiropractic
    56 Winthrop Street
    Concord, MA 01742
    (978)3692266
    (978)3695205- Fax
    www.drrobichaud.com

  • MEDICARE WAIVER FORM: 2026

  • Dr. Robichaud is a Medicare Provider and we will submit all of your claims to Medicare. If you have a supplemental insurance policy (Medigap) we will need that information as well. Once Medicare processes your claim, they will forward it to the supplemental carrier. After both insurance companies process your claim, you will receive a remainder statement for any co-payments or deductibles that are due.
  • We have a system in place to securely store a payment method to cover these remainder balances. You will receive an email any time that card is charged. If you prefer to receive a paper bill for these balances rather than store a credit card, please let us know.
  • The Chiropractic Benefit under Medicare is very specific.
  • They pay for spinal manipulation to correct a subluxation (altered spinal motion).
  • That's it. They do not cover anything else. All routine office visits use spinal manipulation, so that charge will be covered by Medicare and your Medigap policy. You will be responsible for payment of any other charges.
  • The 2026 fee schedule is as follows:
    New Patient Examination: $200.00
    Established patient re-examination: $125.00
    Spinal Manipulation (office visit) $60.00
    Manual Soft Tissue Therapy: $5.00
    Applied Physiotherapy: $5.00
    Kinesiotaping: $5.00
  • I have read the waiver policy, and understand I am responsible for payment of any remainder balances.
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