What do I need to give to the patient in order for them to submit their insurance claims themselves?

My Response:

Realize that the whole idea of DCs submitting the patient’s claim forms was an attempt at being a “personal service” that probably degenerated into merely a way to create a more direct conduit for the money!

Based on several conversations I’ve had with chiropractors who have tested the following hypothesis, I believe that what was once a personal service is now actually reducing the coverage the patient is able to receive!

You’ll need to own the following concept and be able to communicate it to patients: The patient’s insurance policy is an agreement between the patient and their carrier. You, as the chiropractor, are not a party to this contract, and as such, when you submit a claim on behalf of the patient, you are looked upon suspicion. Maybe you’re one of those chiropractors who over treat, selling the patient care they don’t (in the eyes of an insurance company focused on symptomatic relief only) believe is necessary.

So various foot dragging strategies are employed in an attempt to shake you. Lost your file. Please resubmit. Sorry, forgot to dot an “i” on page five of the report you sent (that we’re not going to read). Etc. After they’ve exhausted the stalling techniques they simply arbitrarily cut your fee in half!

In light of this, you can imagine that when the patient pays the chiropractor and then the premium payer asks to get reimbursed from their carrier, an entirely different dynamic is in play. Those who have tested this idea report the lag between claim submission and the patient receiving their check is closer to three weeks. Thus, many offices will charge the patient for their care on their credit card the day after their billing cycle closes and use the 45-day float from when their bill is due to finance their care.

One other issue. When the patient pays for their care from the beginning, there is a much greater likelihood of continued care beyond the minimal amounts sanctioned by their insurance policy, rather than suddenly asking the patient to pay full fare when they’re feeling better after a dozen visits or so.

You’ll need to offer the patient a “super bill” or a HCFA Form that they can submit to their carrier. And one more thing. Be prepared for some patients to walk. “My other doctor accepts my insurance…” Have the courage to stand your ground and simply refine your explanation of the mechanics of insurance these days.

Bottom line? Communicate to patients that it is actually in their best interest to pay you and get reimbursed by their carrier. They’ll get more coverage, they are less likely to get their claims arbitrary cut, and the foot dragging most DCs are familiar with is, well, bad form when you're doing it to the folks who send you their monthly premiums!

Bill