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Absurdity: Chiropractic and Health Insurance
As anybody who uses health insurance to pay for their chiropractic treatments knows, the DC (Doctor of Chiropractic) needs you to come in about 10 times or more. Why do you need so many visits when you usually feel better after 2 visits? Why should you keep coming in when it is obvious that the doctor doesn’t do very much on each visit: maybe 10 minutes of which 5 minutes is spent introducing himself and asking about your family.
You have just figured out with your own two eyes (and your body) the answer but I want to explore the depths of what you have already observed.
I will not deal with the doctor’s explanation of the Vertebral Subluxation Complex (VSC) and the other horseshit he tells you. Like a religion, some chiropractors are ‘true believers’ and I will not disagree with people’s faith or their verbiage about ‘selling chiropractic’. I do not follow anything but science and there is no science in their explanation. In short: no other medical profession can find a VSC, there are no tests to prove that you have it or means to indicate that you do not have it any longer. You draw your own conclusions about its validity.
By the way, I spend 30 minutes with each patient and almost none of that treatment is me talking. Can other chiropractors also do this? Yes, but they will not because they need to see another 15 patients that day.
So why 10 visits? That is what your insurance company states that they will pay for your musculoskeletal issues. In fact, they won’t pay for more than 3 and then the doctor has to BEG for the remaining payments. Your $30-$40-$50 copay is not enough to pay his bills. He needs that $45 for each visit that the insurer states that they will pay. They don’t pay it for many months and lots of billing disputes FOR EACH VISIT but with a billing clerk working 8 hours a day your DC should get paid. Eventually. Maybe. Someday. Perhaps.
Or not. Your insurance company is working hard to make sure that your premium dollars are going to pay for only the best verified treatments for you.
Hold it, I have to sit down. I need to catch my breath from my laughing at what I just wrote! Phew! That was so funny!
“Working hard”? “Verified treatments”? How hard is it to deny payments correctly coded for real treatments done on a live patient who is in front of the doctor? It takes ‘chutzpah’ but it is not hard to do what your employer tells you to do without thinking or correct reasoning.
So who pay for that billing clerk? The money from the insurance company and your copay. So… the money from the insurer pays for the staff to contact the insurer to clarify what was already informed to the insurer to ask them to pay. The cycle never ends. The insurer faces no punishment for not paying the doctor in a timely manner so they don’t pay because this saves them money. Times the thousands of doctors the insurer doesn’t pay. I mean, chiropractors. Everyone will get paid in a timely manner except the chiropractor because insurers feel ‘good’ about not paying them.
I do not take insurance any longer (since November 15, 2019) and I can resolve your musculoskeletal issue in one visit. Yes, 1! One.
So, do I use a special trick or do I have magic or do I drug the patient? No – I am decent but not the best. Every other DC can do the same but they need that insurance money so 10 visits is what it will be. 10 visits for which 2-3 will be paid and 7 more will be fought for the next year.
More truth for you? Let’s just suppose that insurers pay for the care of 12 medical entities and professions: hospitals and PTS, OTs, MDs, DOs, RNs, NPs, DMDs, DDSs, and so on, in addition to DCs. How do they police what is a legitimate charge and what is not.
Well, I know that every insurer has 4 employees to go over the claims of chiropractors in each state. Chiropractors cost the insurer less that 1% of their budget. For those who are weak at math 1/100 is $1 for every $100. But I said LESS than 1%. Try .01%: so not $1 for every 1000 (that is THOUSAND) but $1 for every $10,000 (TEN THOUSAND).
Wow, 4 people assigned to the claims of chiropractors! So there must be, what, 100 people assigned to hospitals and 20 people for each of the other professions, right?
No, just the 4 assigned to chiropractors. There are no other employees assigned to other areas of medicine for reviewing billing.
4 full-time employees to look at the bills of a part of the budget that is only .01% of money paid out. There are 2000 chiropractors in NJ of which about half continue to practice and bill insurers (minus me),
4 employees so that is 250 chiropractors for each employee (assuming that they all use the insurance company you work for). That is not how it is parsed out. Each employee is assigned 250 but they also review another 250 to show their dedication and look over each others’ work to see if there is anything missed. Denying payment and saving your employer money is a lot of work. Can you imagine how hard it would be if you had to look at the other medical professions – you might save thousands of dollars (or millions) instead of the $8-12 per claim that you are doing now!
Do you recall that I do not take insurance from insurers any longer so what does the person who is assigned my office do to show how good they are at their job? There is no present day money to save so… they become ‘historical billers’ like any good employee trying to show why they are ‘necessary’ on the job (and to fill their 9 hour workday) to ‘earn’ their paycheck.
BCBS (Blue Cross/Blue Shield) of NJ started sending me letters a year after I STOPPED TAKING MONEY FROM THEM to announce that they had ‘overpaid’ me 3 years ago. How much money was involved? How many hundreds of dollars are involved here to go back so far?
$18.65. Less than $20.
I received 2-3 letters a week for over a year, each signed off by a different employee about this money and asking how I intended to repay it. This went on for a year and I would fax back to the number provided mocking them.
There was no reason to be nice so I mocked them in a fax.
A year. $18.65. It was obviously someone’s job to go back 3 years of my billing to do this. Let’s just say that they are paid $35,000 a year (probably much less) and this is what they do when they have trouble denying enough payments to chiropractors – they do ‘historical billing’ ‘clawbacks’.
The amount that hospitals pay their upper management for a month from the money collected from insurers would allow all chiropractors in NJ to give free care to every citizen in NJ for the whole year.
You do not need 10 chiropractic visits. You need health insurance to pay chiropractors better.
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