I stopped accepting insurance on August 8, 2016 for several reasons I have outlined below. To summarize, continued use of insurance was moving my office toward a large volume, reduced doctor-patient interaction operation and I believe that this was going to result in reduced quality of care for my patients.
When I opened my practice here in Knoxville, I had five care guidelines, all of which are patient-centric.
1. I vowed to see patients at their scheduled time. 10:00 means 10:00, not 11:30.
2. I would keep my overhead low so that I could keep my cost of care reasonable and affordable.
3. I would be available to all patients who enter my office — that is I would not hide behind a door while a staff person decides if your issue requires my attention
4. I would provide the care necessary to fix the problem as fast as possible; treatment plans that require multiple visits per week that extend for months on end is NOT the type of care I provide.
5. I would use specific, quantifiable criteria to gauge patient progress and reduce office visits accordingly, therefore reducing the overall cost of care for the patient.
Continued use of insurance would mean that I have to abandon the above care guidelines, which I refuse to do. Additionally, BCBS has dramatically modified their reimbursement schedule, which will further reduce payments to chiropractic physicians.
I am CONFIDENT that you will find no better care than in my office and I will do everything within my power to continue to provide the same, highest quality care I have always given my patients.
For a more complete discussion of some of the reasons I will stop accepting insurance you may continue reading.
RATIONALE FOR DROPPING INSURANCE
After 6 months of accepting insurance I realized that it was having a negative impact on the type of care I wanted to provide in this office. I experience the same pressures other medical professionals find when insurance companies dictate the type of care a patient should receive. Let me provide you with a few examples:
1. Insurance companies pay about half of the regular cost of services provided. This means that for me to make this viable I will need to start double and triple booking, that is seeing 3 patients in 15 minutes rather than the 1 I see now. Additionally, they will not cover all costs of treatment. For example, insurance does not cover any of the ART (Active Release Therapy) I do pre and post-adjustment on the muscles/ligaments/and tendons, which greatly increases the effectiveness of treatment and reduces the total number of visits needed. Additionally, in order to get the money from the insurance companies there is dramatically increased workload that has to be done to continue to submit, track payments per patient per visit, and then follow up by billing patients for charges not covered by insurance. This brings the cost per visit to 3x-4x the cost of a “cash/credit” patient who doesn’t use insurance, yet insurance ends up paying about half.
2. This leads to reason #2. Double and triple booking results in reduced treatment time, which is why you will usually only have 5 minutes with your family physician or chiropractor, and may wait for an hour or more to see them. This type of care is completely unacceptable to me and I refuse to shortcut care for the sake of declining reimbursement.
3. The only way for a doctor’s office to make insurance work is to do high-volume. This is why some of the larger chiropractic practices seem more like assembly lines (as many many patients have told me), which are heavy on “therapy” and light on doctor-patient interaction. Therapies like electrical stimulation (e-stim or TENS units), hot/cold packs, and “roller tables” are used extensively — not because they fix you but because they can bill insurance companies. There is a time and a place for these therapies, but certainly not on every person who walks through my door.
I never set out to be a high-volume practice and want to maintain the high standards of care I set for myself.
4. If I were to increase my use of the above therapies, my patients will be in my office for at least a half hour or longer. Given this, it would be impossible for me to continue to see 100% of my patients within 10 minutes of their appointment time (95% of the time I will see you on or before your scheduled appointment time).
Everyone I have asked has stated they appreciate the on-time nature of my office and do not want to be here for more than 15 minutes. This allows everyone to schedule their visits, knowing that they will not have to sit and wait, or be prolonged with extended and often unnecessary, treatment.
5. I need to maintain low overhead to keep my cost of care as little as possible. If I were to continue to accept insurance I would be forced to hire at least one full time staff person to handle the mountain of paperwork and subsequent patient billing, which will immediately drive up the cost of care.
6. Only about 25% of my patients are actively using insurance. Most of these patients haven’t met their deductible yet. Given that the majority of my patients do not use insurance, it would make no sense for me to hire staff to handle all the paperwork involved, which would subsequently increase the cost of care for everyone.
For these reasons I have decided that this office will best serve its patients by moving away from insurance and back to a pay-for-service model.
If you would like a superbill for you to submit to insurance companies, please request it from me.