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Running On Empty

chiropractic and the pressures of insuranceHow do you overcome the tendency for chiropractic patients to discontinue care (or not even begin) if their insurance won’t pay for it?

This question has been rattling around in my brain for the last six months or so. It’s a common source of frustration of many chiropractors. Angst about this issue prompts far too many chiropractors to succumb to accepting insurance assignment, surrendering their practices to claims adjusters who have little understanding, respect or interest in chiropractic.

I finally know what the answer is! But before I reveal it, let me pose a couple of questions:

1. Your car is making expensive noises. You’ve pretty much maxed out your credit cards, but you have an emergency stash that could be tapped. Do you tap it or wait until your car’s condition worsens?

2. Are you more likely to stop at the gas station to fill up when your tank is half-full, a third-full, a quarter-full or when the indicator shows you’re running on fumes?

Naturally, there isn’t a right or wrong answer to these. But they reveal the value we place on having a dependable automobile and having a reserve in our gas tank. Thankfully, we each get to prioritize these issues the way we wish. Could I talk you into changing a single one of these choices? Could I persuade you of the benefits of never letting your gas tank get below half full?

I doubt it. And this is true for how we each value our health as well.

Since you place a high value on health (after all, you did choose it as a career!) you’re easily astonished when patients choose expensive automobiles and take exotic vacations rather than attend to their health. My advice? Get over it. There is NOTHING you can say or do to reprioritize their health. Well actually, there is one thing you can do.

You can make it easier for patients to abandon their naïve belief and acquire a more responsible attitude. How? It can take years, maybe a decade or longer, but you could try this procedure:

1. Recognize you’re powerless when it comes to reprioritizing someone else’s values. (In fact, patients resent it when you try.)
2. Explain how muscles and soft tissues supporting the spine do the majority of the healing after symptoms subside—which is rarely covered by insurance.
3. Warn that if they discontinue care as soon as they feel better they’re likely to suffer a relapse.
4. Plead that they not blame you or chiropractic.
5. Urge them to return to your office, knowing there won’t be a single I-told-you-so guilt trip.
6. Discuss the best way for them to announce it will be their last visit with you, knowing that you won’t try to talk them out of it.
7. Keep your eye on the horizon. The prize is a constant flow of reactivations and patients who love you and will refer others.

This isn’t about resignation or giving up. It’s coming to grips with the fact that when it comes to patients, the only power you have is whether to adjust them or not. Which happens to be trumped by whether they show up or not—which they control.

Comments (4)

Ian Culbert, DC:


I've heard you speak of this before, but I needed a refresher. I was chatting with my team about this at our staff meeting this week. A patient's decision is out of our control. As long as we, as a team, feel that we communicated our best and informed the patient about their condition, then we have done our job. It does take away a lot of stress to know it's not us that's being rejected. The patient just values soemething else (ie. money) more. Thanks for the reminder!

Dr. Carol Grant:

I write a newspaper column every week and I'm going to take the ideas here and write something to the public. Ya never know, people might find this attitude more comfortable. Thanks

Howard Boos:

Bill, thank you for your insight!
Sometimes the obvious isn't so obvious until someone articulately communicates what's so.
I find your recommendation also frees me up to relax in practice and focus more on what I can do. Anytime I notice burn-out creeping in I'll frequently find it's because I'm trying to control what I have no control over.
Rocks are hard, water is wet and patients are patients.
Thank you again.

Tony Russo:

Bravo Bill,
By far one of the best of your many valuable advises. Like anything worthwhile, this one ain't easy. I should know. I'm one of those "angst" Chiropractors you refer to. But it its well worth the pain. All we need the courage. Keep up the excellent work.

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From July 7, 2007 5:03 PM

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