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“I can always find something to bill an insurance company for…”

drx.jpgThis is an all too common belief held by many chiropractors who are naive, lazy or inclined to steal. Naturally, this lack of integrity creates far more problems in the long run than it solves in the short term.

Chiropractors who see a patient’s insurance policy as some sort of entitlement are probably the worse abusers. Either they don’t know how insurance policies work, or do, and choose to blur the boundaries for their personal gain.

In case you didn’t know, the purpose of a health insurance policy is NOT to insure the patient’s health!

That's right. It's merely designed to help pay for the treatment necessary to return as nearly as possible, an insured individual to their pre-incident level of function. In other words, if a patient has a bout of back pain, it is NOT the responsibility of an insurance carrier to pay for the care necessary to reverse years of neglect. Instead, their responsibility is limited to overseeing the fastest and cheapest restoration of the patient’s functional capability.

Granted, a case could be made that some type of ongoing supportive care might help reduce the likelihood of a relapse. But that’s not how the insurance companies see their obligation. Imposing your beliefs about the value of nonsymptomatic care, self-righteously justified as being in the patient’s best interest, may be thoughtful, even clinically correct, yet it is self-serving and unethical.

Chiropractors who see patients as merely reimbursement mechanisms often suffer a form of communication atrophy. Explaining the limited responsibilities of the insurance carrier takes work. Not to mention, it may increase the likelihood of the patient discontinuing their care once symptomatic improvement has been achieved. Instead, the chiropractor finds ways to justify keeping the insurance carrier on the hook for their spinal ministrations. This seems especially true of the proverbial once-a-month Medicare visit in which an episode of care is never officially completed.

The biggest offenders are often those who have known nothing but indemnity insurance throughout their professional career. Apparently, adding reimbursable procedures is less work than developing a compelling communication strategy that transitions a percentage of patients into maintenance care which they would pay for themselves. (Which may seem impossible if you don’t believe that what you offer is valuable enough that a patient would pay for!)

At the root of this is a rationalization to steal. Yes, insurance companies don’t “get” chiropractic. True, insurance carriers have a misguided notion about the nature of health. Naturally, they should reimburse more. But they don’t. And the fact that “everybody does it” is not only a lie, but will give you little comfort when you are confronted by an insurance company audit or when asked to appear before your licensing board.

And all you wanted to do is help people.

Document what you find. Prove that what you’re doing is making a difference and that there is every reason to expect that your plan will produce further functional improvements. And document those. At the moment you’ve reached the point where their neglect, their lifestyle and the limitations of their age and interest are exhausted, dismiss them and their insurance carrier from further obligation. Make your case for continued supportive care on a cash basis. Warn of the likelihood of a relapse. Honor the patient’s choice.

And then help the next person who wants it.

Comments (1)

Interesting commentary Bill. What if it's the patient's choice to try and extract as much care as possible out of their over-priced insurance policy?

WDE: Seems to me you’d want to be consistent, whether it’s a patient asking you to bend the rules or your own streak of self-righteousness, compelling you to “stick it” to the insurance company.

“I’m sorry Mrs. Jones, I wouldn’t be comfortable doing that. Not only are the penalties severe if it were ever discovered, I wouldn’t be able face myself in the mirror. How ‘bout I have Barbara explain the benefits of our ChiroHealthUSA plan that makes our post-insurance care affordable for just about anyone?”

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From January 11, 2012 12:52 PM

This page contains a single entry from the blog posted on January 11, 2012 12:52 PM.

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