• Nick Gardner DC

Why I Don't Take Insurance

I get quite a few calls each week from people who are in pain and need care. They have insurance and their first question is usually if I take their insurance. I tell them I don't and they move on to the next clinic. I estimate I would have a 30% bigger practice if I took insurance as payment. So why don't I take it? Am I leaving money on the table?

Insurance is just one way to pay for healthcare costs. I don't take it for one big reason, I don't want to become an insurance chiropractor. What is an insurance chiropractor? An insurance chiropractor is a doctor who does what insurance allows, in the time allowed. They let insurance dictate how they practice. This shows up in practice in a number of ways.

· First, many insurances don't pay for a exam from a chiropractor. Insurance doesn't pay, so "insurance chiropractors" either opt to do a very quick exam or in some cases no real exam at all. The exam is where you figure out what is actually going on with the patient. Without a good exam your likelihood of determining the correct diagnosis is very low. Without a proper diagnosis your likelihood of effective treatment is next to zero. I always do an complete exam and history, so I always know what's going on.

· Second, insurance will only pay for a limited time and select services. Insurance tells the doctor what services it will pay for and which ones it won't. For certain things like a massage it will even dictate minimum time it will pay for. Insurance chiropractors are not used to asking for real payment for services and their patients are not used to pulling out their wallets for chiropractic care. This means that "insurance chiropractors" usually end up doing only what insurance will pay for. Regardless of effectiveness, regardless of quality and with little regard for the patient as an individual. Unlike insurance chiropractors, my patients pay for my time. In that time I can do what is most effective and perform a variety of high quality treatments.

· Third, the ever decreasing time with the chiropractor. Ever noticed you only see your

insurance chiropractor for 5-10 minutes, there's a reason for that. Insurance will pay for certain services to be performed, but for some services it doesn't say the chiropractor has to perform them. Insurance chiropractors take advantage of this by hiring low paid "assistants". Unlike an MD having nurses perform tasks for him, chiropractic assistants are often uneducated in chiropractic and health. An insurance doctor can easily have 5-8 rooms of patients operating at the same time because, as dictated by insurance, their only job is to do the chiropractic adjustments. They don't have to be present for the rest of the therapy, so they aren't. Having uneducated and unskilled assistants perform your therapy leads to a drop in quality. You should ask the assistant working on you much they get paid. I'd bet it's close to minimum wage. You're paying top dollar for a low paid assistant to do more than half your therapy, you deserve better. Insurance based patients often have less quality standards because they believe insurance is paying. It feels like free care to them. It isn't. I spend 45mins to an hour with each patient because I consider the entire therapy process to be my job, not just select services.

· Fourth, by reading the above points you may come to think that insurance companies are in full control of chiropractors, you'd be right. It is much worse than you realize. A busy insurance based clinic can gross millions of dollars over a few year period. You'd think that's great making millions, but there are big costs to taking insurance. A big clinic will need 1-3 people dedicated to filing insurance claims, re-filing denied claims, doing special paperwork and using special billing software. It's a lot of expensive, moving parts to make sure you get paid by insurance. The biggest expense of all comes later. When you agree to provide care for an insurer you sign your practice to them. They can come in and review patient files and do payment audits whenever they like and there is nothing you can do. As mentioned above most insurance patients are all being treated the same with little justification for why they are being treated that way. The insurance company can rule that patients received unnecessary care and issue the doctor a request for return of funds. That means the insurance company tells the chiropractor "you owe us $500,000 to a million dollars". These claw backs are very common and the average audit is once every 7 years per insurer. The chiropractor has already rendered services and paid the premium costs to submit to insurance is now looking at a half million dollar bill or go to court. My patients pay me directly so I never have to deal with this kind of financial devastation.

I hope this had shed some light as to why I don't take insurance and ,barring some serious reforms, I never will. Too much control, too little commitment to quality and too financially risky.

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