What Does Medicare Cover?

  For Chiropractic care, Medicare currently covers only treatment of the spine. So shoulder, knee, ankle, wrist, etc., problems aren’t covered. 

The Chiropractic profession is working on changing this---on getting Medicare coverage for the whole body---and hopefully, it will happen soon.

In the meantime, when I see Medicare patients, I make careful documentation of their spinal symptoms and treatment, and report these to Medicare on the required forms and according to the specific Medicare coding system. Medicare patients in my office pay my fee at the time of service. 

Typical allowances for Chiropractic patients in Santa Cruz County are between about $48.00 and $33.00 per visit, depending on the patient’s complaints and the concomitant treatment. 

        Of these allowances, Medicare will reimburse the patient 80%, and the typical Medicare supplement policy will cover the other 20%.  Allowances do change annually, but often by only a few cents.

Nerve Impingement in the Neck

 “Impingement” of a nerve simply means the nerve is somehow negatively affected. It might be pressure, abrasion, stretching, or other constriction, causing symptoms such as pain, numbness, tingling, burning, hyper- or hypoesthesia.

In the neck, nerves exit the spine and travel out into the shoulders and down both arms & hands. These nerves are called the “brachial plexus.” Impingement of the brachial plexus is called “thoracic outlet syndrome." 

There are several common sites of impingement of the brachial plexus, including between muscles on either side of the neck, and between the clavicle and the first rib. The patient may complain of pain or numbness or tingling in the arm(s) or hand(s).

This can be due to, among other causes, poor posture, trauma such as whiplash, over-exercising or imbalanced exercising, stress, or unaccustomed activities--often some kind of work with the arms over the head.

Once I identify the site(s) of impingement, I make precise, directional adjustments with the Activator instrument and give the patient ergonomic and home care counseling and appropriate stretches.

A "Winged" Scapula

  A common cause of discomfort and restriction in the upper back and shoulder is an outwardly rotated, or “winged” scapula.

When this occurs, symptoms can present around or underneath the shoulder blade itself, or in the involved shoulder and arm. Muscles may be in reactive contraction; the range of motion of the shoulder and arm is often restricted.

I reposition the scapula to its normal orientation, using the Activator instrument. It is also necessary to adjust the humerus, the upper bone in the arm which articulates with the scapula, as well as the radius or ulna in the forearm, and some of the bones in the wrist, because the “winging” of the scapula reverberates all the way into the shoulder and down the arm.

Ouch! Pain in the Toes

  Recurring pain in a toe or toes, which may feel like a cramp, can be related to an aberrant gait cycle. When a patient presents with this complaint, I watch them walk. 

Commonly, during toe-off, when the weight-bearing foot is rolling forward as the heel of the opposite foot takes the body’s weight, the toes on the “rolling” foot are "pushing." This not only assists in balance, but helps propel the walker forward.

If this action of the toes is unnecessarily strong, toe pain, either from stress on the joints or overly-contracted muscles, can be the result. This is common with vigorous walkers or “power” walkers.

Shoes that are too stiff can also be part of the problem. The walker must work harder during the gait cycle to overcome a stiff shoe. 

When a patient has this toe pain, I adjust the lower extremities, with careful attention to the feet and toes. then advise about proper walking shoes. I show the patient how to moderate their gait to help this condition resolve.

Lateral Ankle Pain

  Pain on the outside (lateral side) of the ankle can be due to a misaligned lower fibula. 

The lower end of the fibula, the smaller bone in the lower leg, forms the “bump” on the outside of the ankle. It is attached to the lower end of the larger bone, the tibia, by ligaments. Even a mild sprain of these ligaments can bring on pain.

Aside from a ligamentous sprain, however, the lower fibula may become stressed, or misaligned, in multiple directions, which results in pain, An inferior misalignment is quite common, as is a posterior misalignment. 

I correct these misalignments with the Activator instrument, precisely and comfortably for the patient, bringing relief.