Why I Don’t Participate with Insurance
Hello and welcome to my blog!
Dr. Super’s House of Health, like many other chiropractic offices, is a cash-based practice. Today I thought it would be important to explain why I chose not to participate with insurance companies. This decision had several draw-backs, but gave me a greater degree of freedom when treating my patients. I took careful consideration when designing my office and it turned out, everything concerning my business plan would later be based on this decision. How many people I needed to treat in a day, how much I needed to charge each patient, what equipment I could afford, how many employees I needed and could afford, what services I could offer, how long my visits could be? All of these questions were previously dictated by the insurance companies for me; but no longer. Without being tied down by insurance, I was free to answer these questions with my patient in mind, instead of what insurance required.
Many people expect their insurance companies to have their best interests in mind, after all, that’s what you pay them for, isn’t it? Patient’s pay thousands of dollars a year to insurance companies to help them in time of need, to allow them to receive necessary care, and to allow them to pursue their health goals. However, the reality that many patients face concerning their insurance benefits is rather bleak and disappointing. Most patients understand very little about what their insurance will cover and how much it will cost, despite already paying thousands in premiums and picking out a contract supplied by the chosen insurance company. Part of this confusion is that insurance gets to play dirty; they get to change the benefits they offer or how much it will cost in the middle of a contract period. They get to determine how much doctors get paid for their services, what services they will cover, and what is considered “medically necessary” according to their own definition. Most insurances offer plans with high deductibles and copays which are not part of your monthly insurance payment. According to an employee survey conducted in 2019, the average American household spends $7,188 per year, or $599 per month for single coverage (KFF, 2019). A plan that also provides coverage for your spouse and kids has an average premium of $1,714 per month, or $20,576 each year (KFF, 2019). That price doesn’t include a deductible (I have seen some as high as $13,000 for a family, or $8,000 for an individual) or out-of-pocket max.
I’ve been working as a chiropractor since 2018 and have worked at two separate high-volume offices before starting my small private practice. Both offices accepted insurance and in my opinion, were ruled by insurances. Accepting insurance means accepting their rules and contracts. Most patients don’t realize that each insurance company agrees to pay the doctor a different amount for the same billing codes. One patient with Highmark Insurance brings in $80 from insurance for a new patient exam, while another patient with Aetna may bring in $34 for the same services. One insurance might allow the doctor to see a patient 60 times a year, while another insurance allows the doctor only four visits a year. Doctors must sign agreements accepting these various payments and terms which is why they often lose money when in network with lower premium plans or state funded insurance. I have seen whole offices base patient care off of “who’s insurance pays the most”. For example, I was allowed to see a Blue Cross Blue Shield patient for 8 minutes while Capital Blue or ASH was only allowed 3 minutes a visit. This was based solely on how much we could bill insurance for a visit and not based on patient need.
There are offices that construct their entire business model off of insurance. They will target patients with high paying insurance, convince you that you need all 40 of those visits (the max insurance will pay for), and bill you for every covered therapy under the sun, whether you clinically need the therapy or not. How else can a large office pay for the overhead involved in accepting insurance? How else can these offices afford being paid less for services, paying for employees to bill insurances, and billing managers sending patients their EOB and bill? The one office I worked at, there was an employee whose sole purpose was to battle insurance companies on the phone, all day everyday, to pay the doctor for services rendered. Why should so much time and energy be spent on pleasing, arguing with, and waiting for insurance companies to pay instead of on patient care? Since when did insurance companies get to decide what services your doctor is allowed to provide, how often, or for what price? Don’t even get me started with how insurance companies discriminate against different patient populations or health care professionals (this could be a whole separate blog post!).
Let's be honest, most people don’t feel like their insurance company cares about them or their health at all. If they did, they would cover preventative procedures or include benefits for mental health, vision, and dental (which most don’t include without extra premiums). How can insurance companies make money when you are healthy? Would you need them as often or as much? Would you pay an arm and a leg every month out of your hard-earned paycheck if you knew they only benefited off of your sickness? Let’s ask another question that might put this in perspective; what does an insurance company do with your premiums if they aren’t paying the doctor or covering your health care costs? They invest the money into other interest-generating asset or businesses of course! Insurance companies can find safe, short-term assets to invest in and generate additional interest revenue for the company while it waits for possible payouts. This includes Treasury bonds, high-grade corporate bonds, and interest-bearing cash equivalents (Ross, 2022). Insurance companies can also coordinate with Big Pharma companies on which brand names are preferred and covered by premiums and often allow rebates to be accepted by the insurance company on behalf of the patient, instead of passing on lower premiums to patient’s themselves. Because of this, “health insurers and pharmaceutical companies are pointing fingers at each other for the rising cost of prescription drugs as scrutiny over drug spending intensifies” (Livingston, 2018). Many say “follow the money” when trying to learn motive.
So let me ask you: If a company makes money off your illness by providing you with drugs, while controlling what procedures and services you are allowed to receive, are they interested in you being healthy? No! That's why so many chiropractic offices are cash based. We are in the business of preventing illness and injury and treating musculoskeletal issues without expensive surgeries or drugs. How can insurance companies make money off of you if you are no longer sick? How do they sell you on spinal fusions when your disc injury was resolved with PT and chiropractic treatments? How do they sell you Botox when you no longer have migraines? They cannot. Insurances make money off of you being sick. Therefore they have an incentive to keep you that way.
I don’t accept insurance at my office because I refuse to participate in a system designed to keep you from being well; A system designed to make you sick, keep you sick, and maximize benefits off of your sickness. I refuse to let insurance dictate how I can treat you, what equipment I can use, how many times I can see you, or what I am allowed to treat. I value the freedom I have with how much time I can give a patient based on need, not how much I will get paid. Not accepting insurance has allowed me to keep my overhead low, which keeps my prices low. Not dealing with insurance companies allows more time to focus on the patient in front of me and allows my patient to choose what intervention or care is right for them.
I hope that my patients realize I made this decision for them. I understand how people get frustrated when they pay so much money a year towards insurance, and I don’t accept their plan. I hope they realize the only way I can retain my power and help them heal the way they DESERVE is by staying out of insurance networks. More and more offices are moving towards this approach and accepting less and less insurance carriers. For most offices this is because they are simply not making enough when seeing insurance patients, but for me, it's because I value my autonomy and I value my patient. I care about your health. Can your insurance company say the same thing?
Feel well and do good,
ADIO
Dr. Tabetha Super
Published: Sep 25, 2019. (2020, September 14). 2019 employer health benefits survey. KFF. Retrieved February 20, 2022, from https://www.kff.org/health-costs/report/2019-employer-health-benefits-survey/
Ross, S. (2022, February 8). What is the main business model for insurance companies? Investopedia. Retrieved February 21, 2022, from https://www.investopedia.com/ask/answers/052015/what-main-business-model-insurance-companies.asp#:~:text=Most%20insurance%20companies%20generate%20revenue,effectively%20and%20minimize%20administrative%20costs.
Livingston, S. (2018, March 28). Health Insurers, big pharma play blame game over drug prices. Modern Healthcare. Retrieved February 21, 2022, from https://www.modernhealthcare.com/article/20180327/NEWS/180329919/health-insurers-big-pharma-play-blame-game-over-drug-prices