The words we use, and what they mean

Your definition of health

What do you want to be able to do? Gardening. Dancing. Sleeping comfortably. Keeping up with your own day. Your answer comes from the life you want to live — and it is different from your neighbor's, your doctor's, even your spouse's. Nobody else gets to write it.

The World Health Organization's definition of health

"A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." A broad picture of health across people and communities — the global definition.

Your health insurance plan's definition of health

Your health insurance plan does not define health. It defines what care it helps pay for — the services on its benefits list, and the rules for receiving them.

Three answers that sound alike and are not the same. One is yours. One is the world's. One is a contract describing coverage.

Health insurance plan

A health insurance plan sets the covered services, rules, and costs that apply to your coverage. Private plans are contracts; Original Medicare is a federal program with its own rules. Employer plans, Marketplace plans, Original Medicare, and Medicare Advantage can differ. "I have health insurance" is only the beginning; the next question is "What does my health insurance plan cover, and how do I use it?"

Original Medicare

Medicare coverage managed by the federal government. It includes Part A and Part B and has its own coverage, cost, and paperwork rules. Some people add private coverage alongside it; others choose a Medicare Advantage plan instead.

Medicare Advantage

A Medicare-approved plan from a private company, an alternative to Original Medicare. You still have Medicare, but the plan's rules apply to your care. It provides your Medicare Part A and Part B coverage and may offer extra benefits, and its network, prior-authorization and cost-sharing rules can differ from Original Medicare. Original Medicare's ABN form does not govern a Medicare Advantage coverage decision; the plan's own rules and notices apply.

Your health insurance plan's list

Our everyday shorthand for your plan's covered benefits together with the rules that go with them — what the plan may help pay for, when, and under what conditions. Your actual Summary of Benefits and Coverage and plan documents control.

Medically necessary

A health-plan term for services or supplies needed to diagnose or treat a condition and meeting accepted standards of medicine. Medical necessity does not by itself guarantee payment; your plan's benefits, limits, exclusions, network rules, and authorization requirements still apply.

Covered / Not covered

Covered means your health insurance plan includes a service under its rules. Not covered means the plan will not pay for it under those rules. The reason may be an exclusion or another coverage condition. These words describe the contract, not your worth or the importance of a choice to you.

Benefits

The health care items or services covered under a health insurance plan, together with the plan rules that apply to them. Your coverage documents define your benefits and excluded services.

Exclusion

A service or item your health insurance plan says it does not cover. Exclusions are defined in your plan documents.

Maintenance care

Regular care when a covered problem is no longer being actively treated. For Original Medicare chiropractic services, CMS calls ongoing supportive care maintenance therapy when further clinical improvement cannot reasonably be expected, and that maintenance chiropractic care is not covered. Other health insurance plans use their own rules, so check your plan documents. In this office, maintenance care you choose and pay for yourself is a Tune-up.

Elective care / elected care

On this site, elective care or elected care means care you choose for yourself outside the care your health insurance plan is paying for. It is our everyday usage, not a universal insurance definition. Your own plan documents control the coverage question.

Active treatment

In Original Medicare chiropractic policy, active or corrective treatment is care for a spinal condition when improvement or recovery is reasonably expected. When the condition is stable and further clinical improvement is not reasonably expected, CMS treats continued chiropractic care as maintenance therapy. Other plans may use different wording.

Deductible

The amount you pay for covered health care services before your health insurance plan starts to pay its share for services subject to the deductible. Some services may be covered before the deductible is met, depending on the plan.

Copayment (copay)

A fixed dollar amount you pay for a covered health care service — for example, $20 or $30. Copays can differ by service and plan.

Coinsurance

The percentage of the cost of a covered health care service that you pay — for example, 20% — often after the deductible is met.

Cost share

The share of covered-care costs you pay out of pocket. It generally includes deductibles, copayments, and coinsurance, but not premiums or the cost of services your plan does not cover. In this office, a paid-at-visit discount never changes a Medicare-covered cost share.

Out-of-pocket maximum

The most you pay in a plan year for covered in-network services that count toward the limit. After you reach it, the plan pays 100% of covered in-network benefits for the rest of that plan year. Premiums, noncovered services, out-of-network costs, and amounts above the allowed amount may not count.

Allowed amount

The maximum amount a health insurance plan will pay for a covered health care service. Your plan payment and cost share may be calculated from this amount rather than from the provider's standard fee.

Claim

A request for payment that you or your health care provider submits to your health insurance plan for items or services you believe are covered.

Explanation of Benefits (EOB)

A paper or electronic statement from your health insurance plan showing the claim, charges, allowed amount, what the plan paid, and what you may owe. An EOB is not a bill.

Prior authorization

Approval your health insurance plan may require before you receive certain services or prescriptions. Not getting required prior authorization can affect coverage, and having authorization does not by itself guarantee payment.

Referral

A written order from a primary care doctor to see a specialist or receive certain services. Some plans, including many HMOs, require a referral for certain care.

In-network / Out-of-network

In-network providers or facilities have a contract with your health insurance plan to provide services at agreed terms. Out-of-network providers do not have that contract; your costs and coverage may be different.

Appeal

A formal request asking your health insurance plan to review a decision that denied a benefit or payment. Your plan documents and denial notice explain the process that applies to you.

Actuary

A specialist who uses math and data to evaluate uncertainty and future risk. In insurance, actuaries help estimate future costs and risks for groups of people; those estimates do not predict what will happen to one individual.

Advance Beneficiary Notice (ABN)

An Original Medicare notice used in situations where a provider believes Medicare is likely not to pay for an item or service that Medicare generally covers. The notice explains the reason, the estimated cost, and your options before you choose how to proceed. It is given to you in person, on paper if you want it, before the service — never by a link. It is not the form used for Medicare Advantage plans.

Authorization

For VA Community Care, VA generally must approve the community-care referral before you schedule nonemergency care. In California workers' compensation, the treating physician uses the Request for Authorization process for proposed treatment, and the written decision identifies what is approved. Any patient responsibility follows the program's own rules; some Veterans may owe VA copayments.

Lien

In a car accident case, a signed agreement that lets your care be paid from the settlement of your case instead of at each visit. You, your attorney and Dr. Goff each sign it, and it spells out how and when the bill is paid. Your own lien agreement controls.

Medical payments coverage (med-pay)

Optional coverage on an auto insurance policy that pays medical bills after an accident for you and your passengers, no matter who was at fault, up to the policy's limit. In this office, med-pay is billed first. See S29.

Each appointment carries the name you hear, see online and read on your receipt. Where we used a different word before, it follows in parentheses.

First visit

(Examination.) Your first appointment. Dr. Goff examines you before anything is treated — he finds out what is going on first. For a visit you pay for yourself that is about an hour and roughly 138 measurements. Where a health insurance plan, Medicare or a workers' compensation claim is involved, it is about thirty minutes, because the plan pays for the case and gets the examination the case supports. Original Medicare does not pay for the examination itself. For a Veteran with a VA Community Care referral or a car accident case it is about an hour, because the report is part of what the case needs.

Nothing is treated at a first visit, with one exception: a Veteran with a VA Community Care referral is treated the same visit, because the referral authorizes it. Everyone else begins treatment at the results review.

If you have not been seen here in three years or more, your next appointment is a first visit again.

Results review

(Report of findings.) The appointment after your first visit. Dr. Goff reviews what he found, what it means, what he recommends, and your choices — and you take the written report and your starting scores home. If you choose to start care, this is where it begins, with your first chiropractic adjustment. Bring whoever you talk things over with.

You take a written report home from your results review — what the examination found, what it means, and what Dr. Goff recommends — whether or not you choose to start care.

There is no charge for a results review, however your care is paid for. A return check is also always followed by a results review at your next appointment.

Treatment visit

Your chiropractic adjustment, and the focused therapy or therapies in your plan. Ten, twenty or thirty minutes, depending on what your plan includes.

Tune-up

(Maintenance visit.) Regular care you have chosen and pay for yourself, when a health insurance plan is not paying for that care. It is the same room, the same doctor and the same length as a treatment visit. You ask for it by name.

Medicare's own words for this kind of care: "Maintenance therapy includes services that seek to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition."

Progress check

(Re-examination.) Dr. Goff repeats the tests from your first visit and measures what changed, then gives that day's chiropractic adjustment in the same appointment. For a work injury it is the examination only. About thirty minutes. You answer your questions before you come, and the results are reviewed with you at your next visit.

Inside a plan, the progress check is the next-to-last visit of the plan and is included in its price.

New problem check

When something new has come up, or something has gotten worse, Dr. Goff looks at it first, so he knows what changed before he treats it. About thirty minutes.

Return check

Welcome back. When it has been three months or more since your last visit, Dr. Goff examines you first, so he knows where you are now, then gives your chiropractic adjustment the same visit (for a work injury, the examination only). Your next appointment is your results review.

Under three months since your last visit, you are booked a treatment visit — the same episode of care continuing. Three years or more, and it is a first visit again.

The three-month line is not ours. It comes from the largest contract this practice holds, which defines a new episode of care as a gap in treatment of at least ninety days.

Records review

Dr. Goff reviews the X-rays, scans, or reports you already have from another doctor and explains what they say. About thirty minutes. A visit you pay for yourself; the fee is on our pricing page.

Nutrition review

Dr. Goff reviews what you eat and drink, what you have been told about it, and what you are willing to change, and you leave with a plan you can follow. About thirty minutes. A visit you pay for yourself; the fee is on our pricing page.

Extra time with the doctor

Thirty minutes or an hour with Dr. Goff beyond your regular visit, for whatever you want to review with him. You choose the length. A visit you pay for yourself; the fee is on our pricing page.

Meet the doctor

Ten minutes with Dr. Goff to see the office, ask your questions, and decide whether this is the right place for you. No examination, no treatment, no charge.

Concierge Care

An hour of care with Dr. Goff outside office hours — early, over lunch, in the evening, on a closed day, or at your home — arranged with him personally, never booked online. One price covers everything the doctor does during the visit, and the price is set by the setting you choose.

You can add time by the half hour where the schedule allows — early, evening, closed days and at home, but not at lunch. Add it when you book and pay for it then, and it is less; add it on the day, and it is the same rate as your hour. Fees are given when you arrange the visit, and in writing before it.

Earlier editions of this glossary called this "Protected time." Concierge Care is the name.

House call

A personally arranged visit in which Dr. Goff comes to you. It is arranged as Concierge Care. The equipment included depends on the house-call option you choose, and the price and included equipment are explained before you schedule.

Chiropractic adjustment

The treatment at the center of chiropractic. Physical therapists and osteopathic doctors also learn some joint manipulation, but in chiropractic school the adjustment is the main skill. Every accredited chiropractic program must train students to adjust patients safely, and today Palmer College students take about 435 hours of adjusting classes before they treat patients in a supervised clinic. Dr. Goff has specialized in the Activator Method for over 35 years. Everything else we offer, the therapies, the exercise, the nutrition counseling, is added to it, never a substitute for it.

The American Chiropractic Association describes it this way: "One of the most common and well known therapeutic procedures performed by doctors of chiropractic is spinal manipulation (sometimes referred to as a 'chiropractic adjustment')." ... "The purpose of spinal manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile — or restricted in their movement — as a result of a tissue injury." ... "Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, allowing tissues to heal."

An adjustment is defined by what it is for, not by how it feels or sounds. It is not "when you crack me." Many people expect a sound; a great many chiropractic techniques produce none at all, and some are delivered at a few ounces of pressure. In this office Dr. Goff uses an Activator adjusting instrument, which Activator Methods International describes as delivering low-force adjustments with a mechanical percussive instrument. Medicare counts a hand-held instrument like this, with the force controlled by the doctor's hand, as manual manipulation when its coverage requirements are met; it pays nothing extra for the instrument.

Vertebral subluxation

The term chiropractors use for a spinal joint that has lost its normal motion or alignment. Correcting it is the purpose of a chiropractic adjustment.

The International Chiropractors Association describes it this way: "When spinal joints lose their normal motion or alignment — a condition chiropractors call a vertebral subluxation — it can interfere with those nerve messages." ... "In simpler terms, when one or more spinal joints are not moving or aligned as they should, this can interfere with the nervous system's communication and thereby affect overall health and function."

Medicare does not define the word. It says what has to be shown: "The patient must have a subluxation of the spine as demonstrated by x-ray or physical examination." Where it is shown by examination rather than x-ray, two of four findings are required — pain or tenderness, asymmetry or misalignment, a range-of-motion abnormality, or a change in tissue and tone — and one of the two must be asymmetry or misalignment, or a range-of-motion abnormality.

Why this matters to you: Medicare pays a chiropractor for one thing — "treatment by means of manual manipulation (that is, by use of the hands) of the spine to correct a subluxation." Everything else a chiropractor does is outside what Medicare buys.

Your function number (0 to 10)

On the questions you answer before a visit, you give your function a number. Here is what the numbers mean, word for word as they appear on your sheet:

"LOAD — What life is asking your body and nervous system to carry. ADAPTABILITY — How well your system can handle that load. PAIN / REDUCED FUNCTION — The signal that capacity is being exceeded. A '0' does not mean nothing is wrong — it means your system is coping. A '10' means your system is not coping at all — you cannot function, and you believe you need urgent or emergency care."

On every 0-to-10 line, 10 is the worst. The number is measured against your own normal, not against anyone else's. If you mark a 10, the office calls you before your visit.

Extremity work

Adjustment applied to joints beyond the spine — shoulders, elbows, wrists, hands, hips, knees, ankles, feet.

Focused therapy

An addition to the adjustment. In this office the two focused therapies are hands-on muscle work (your paperwork may say manual therapy) and guided exercise (your paperwork may say therapeutic exercise). These two are what build Better and Best.

Taping

Supportive tape applied over muscles or joints to support an area while you move.

Red light

A device treatment using red and near-infrared light, a form of photobiomodulation. Many health insurance plans do not cover this service; coverage varies by plan.

Laser

A device treatment using low-level or therapeutic laser light to deliver photobiomodulation to a targeted area. Many health insurance plans do not cover this service; coverage varies by plan.

BEMER

A device treatment using pulsed electromagnetic fields (PEMF). Many health insurance plans do not cover this service; coverage varies by plan.

Episode

Our word for care aimed at a present problem, billed to your health insurance plan under its rules. An episode has a shape: a first visit, a results review, treatment visits, a progress check, and a decision together about what comes next. (This is our office's word, not the insurer's — your statement won't say "episode.") A gap of three months or more starts a new episode.

Good / Better / Best

Our three office labels for what a visit contains. Good — the adjustment. Better — the adjustment and hands-on muscle work. Best — the adjustment, muscle work, and guided exercise. These are office terms, not insurance terms, and they describe content, never rank. Good is real care; choosing Good is never the wrong answer, and nobody here will ever make you feel small for choosing it.

Care plan

A set course of visits you buy ahead and pay for yourself — six, eight or twelve — at the tier you choose. Your per-visit price is locked for the length of the plan, and one progress check is included, at the next-to-last visit. Your health insurance plan is not billed for a CARE PLAN. The prices are on our pricing page.

Locked rate

Inside a CARE PLAN, your per-visit price cannot change for the length of the plan.

Standard fee

Our full listed price for a service. Every standard fee in this office comes from one published fee schedule, the same for everyone, reviewed each January. It is on our pricing page.

Paid-at-visit price

Our discounted price when you settle an eligible self-pay service at the visit rather than being billed afterward. Paying further ahead — six, eight or twelve visits — carries a deeper published discount. One schedule, the same for every patient, with separate travel and veteran rates, printed on our pricing page. It does not change a Medicare-covered deductible, copayment, or coinsurance.

Self-pay

Self-pay means you pay the charge yourself rather than a third-party payer paying it. It does not mean you have no health insurance, and it does not describe how you pay — cash, card or anything else. Here it usually describes care you have elected and pay for yourself. The door swings both ways: if a new qualifying episode arrives, your health insurance plan is still there, and we return to its coverage and billing rules. Your plan and applicable billing rules control.

Our promise (the refund)

In your first seven days, a full refund — everything you paid, including visits already received, no questions asked. After seven days, stop whenever you want: what you paid is divided evenly across the plan's visits, you pay only for visits used at that same evenly divided amount — never the standard fee — and the rest is refunded. Your written CARE PLAN agreement spells out the dates and the written request process.

Kept so older paperwork still leads you somewhere.

Examination

See First visit (examination).

Re-examination

See Progress check (re-examination).

Report of findings

Now Results review, both for the appointment and for the written report you take home from it.

Maintenance visit

See Tune-up (maintenance visit).

Protected time

See Concierge Care.

S1 — World Health Organization, Constitution. https://www.who.int/about/governance/constitution/

S2 — HealthCare.gov, Health Insurance Glossary. https://www.healthcare.gov/glossary/

S3 — HealthCare.gov, Summary of Benefits and Coverage and Uniform Glossary. https://www.healthcare.gov/health-care-law-protections/summary-of-benefits-and-coverage/

S4 — Medicare.gov, Original Medicare. https://www.medicare.gov/providers-services/original-medicare

S5 — Medicare.gov, Chiropractic services. https://www.medicare.gov/coverage/chiropractic-services

S6 — CMS, Medicare Coverage Database article A57889, Chiropractic Services (quoted text on maintenance therapy). https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57889 · National policy: Medicare Benefit Policy Manual, Chapter 15, sections 30.5 and 240.1.3. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf

S7 — CMS, How to read a health insurance Explanation of Benefits. https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/get-help/guides-resources/read-explanation-benefits

S8 — CMS, Fee-for-Service Advance Beneficiary Notice (ABN). https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn

S9 — Medicare.gov, Compare Original Medicare and Medicare Advantage. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage

S10 — Society of Actuaries, What is an Actuary? https://www.soa.org/future-actuaries/precandidate/what/

S11 — U.S. Department of Veterans Affairs, Community Care referrals. https://www.va.gov/resources/how-to-get-community-care-referrals-and-schedule-appointments/

S12 — California Division of Workers' Compensation, Request for Authorization rules. https://www.dir.ca.gov/t8/9792_9_1.html

S13 — Activator Methods International, Technique Overview. https://www.activator.com

S14 — PubMed, Photobiomodulation CME part I. https://pubmed.ncbi.nlm.nih.gov/38309304/

S15 — Aetna Clinical Policy Bulletin 0363, Cold Laser and High-Power Laser Therapies. https://www.aetna.com/cpb/medical/data/300_399/0363.html

S16 — FDA 510(k) Summary K231368, BEMER Therapy System Evo. https://www.accessdata.fda.gov/cdrh_docs/pdf23/K231368.pdf

S17 — BEMER, PEMF information (manufacturer page). https://bemergroup.com/en_us/human-line/science/pemf/

S18 — Anthem medical policy DME.00011, Electrical Stimulation as a Treatment for Pain and Other Conditions. https://www.anthem.com/medpolicies/abc/active/mp_pw_a049569.html

S19 — Aetna Clinical Policy Bulletin 0604, Infrared Therapy. https://www.aetna.com/cpb/medical/data/600_699/0604.html

S20 — California Board of Chiropractic Examiners, Rules and Regulations, section 319 Free or Discount Services. https://www.chiro.ca.gov/laws_regs/regulations.pdf

S21 — Federal Trade Commission, Advertising of Warranties and Guarantees, 16 CFR Part 239. https://www.ecfr.gov/current/title-16/chapter-I/subchapter-B/part-239

S22 — ASH Practitioner Services Agreement, California, 06/01/2026, Attachment J, p. 70 (90-day episode gap). Contract document, cited by name.

S23 — American Chiropractic Association. https://www.acatoday.org/patients/

S24 — International Chiropractors Association. https://www.chiropractic.org/what-is-chiropractic/

S25 — CMS, MLN Matters SE1601, Medicare Coverage for Chiropractic Services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/se1601.pdf

S26 — Local Coverage Article A57913, Billing and Coding: Chiropractor Services, Noridian Healthcare Solutions. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57913

S27 — Palmer College of Chiropractic, Doctor of Chiropractic core curriculum (current catalog). https://www.palmer.edu/catalog/doctor-of-chiropractic-degree-core-curriculum/

S28 — Council on Chiropractic Education, Accreditation Standards (2026). https://www.cce-usa.org/uploads/1/0/6/5/106500339/2026-07_cce_accreditation_standards__current_.pdf

S29 — California Department of Insurance, Auto Insurance consumer guide (Form 901, February 2025). https://www.insurance.ca.gov/01-consumers/105-type/95-guides/01-auto/upload/Auto-Insurance-Updated-020525.pdf