56 Winthrop Street
Concord, MA 01742
978 369 2266
www.drrobichaud.com
MEDICARE WAIVER FORM:
Dr. Robichaud is a participating provider in the Medicare Part B program. Most Medicare patients purchase a supplemental insurance plan to cover the 20% of the allowed charge that Medicare does not pay for. These are known as Medigap Plans. We will take a copy of your insurance cards and forward your claims to Medicare for processing and payment. Once Medicare processes your claim, they will forward it to your Medigap plan.
We have a system in place to keep a form of payment on file in a secure platform to pay for any remainder balances that might be due after processing. You will be sent a receipt for any payments made to this stored card. If you prefer to receive a paper bill in the mail rather than have the remainder balance charged to a card, please let us know.
The Medicare Part B plan has a chiropractic benefit that pays for spinal manipulation to correct a spinal subluxation. Period.
Spinal manipulation (routine office visit) will be covered for a certain number of visits per year as determined by your specific plan. You can check with your plan to find out how many visits per year are covered but generally this is about 20 visits per year.
Medicare does not cover the other services we provide here. Keep in mind that Dr. Robichaud is required by law to perform an initial physical examination on any new patient entering the practice to establish a diagnosis and plan of care.
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The 2026 fee schedule is as follows:
New patient physical 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 form and understand that I am responsible for payment of any remainder balances on my account.
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