MEDICARE ADVANTAGE WAIVER FORM: 2026

Robichaud Chiropractic
56 Winthrop Street
Concord, MA 01742
(978)3692266
(978)3695205- Fax
www.drrobichaud.com

Dr. Robichaud is a Medicare Provider and we will submit all of your claims to your Medicare Advantage Plan. He is In Network for the BCBS and Harvard Pilgrim Advantage Plans, which normally carry a co-payment and a deductible. You will be asked to pay your co-payments at the time services are rendered. Because he is In Network for these plans, we will write off the difference between the allowed rate for a Spinal Manipulation and the submitted charge for that service.

Dr. Robichaud is Out of Network for all the other Medicare Advantage Plans. We will submit your claims to your Advantage Plan as a courtesy, and they may make a partial payment for the Spinal Manipulation charge. You will be responsible for the difference between the submitted charge, and what your plan pays (this is known as balance billing).

The Tufts Medicare Advantage Plan (Medicare Preferred) has a policy that does not allow us to "balance bill" a patient once we submit a claim to them. Dr. Robichaud is not willing to accept their fee schedule, so we will give you a paid receipt when you come for a session here. You will have to submit this yourself to Tufts if you want to be reimbursed.

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 Advantage Plans 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 may be covered under your Advantage Plan. 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