Mary is a 45-year-old mother of three who felt it was time to visit a chiropractor. She found a list of chiropractic offices in her area, then picked up the phone and called one. She asked the receptionist two questions: “How much does it cost?” and “Do you accept my insurance?”

The receptionist informed her that there was no charge for a consultation, and that they do accept her insurance. Mary happily scheduled an appointment for the following day. When she arrived, the doctor performed a brief exam and took two x-rays. He placed the films on an x-ray view box and told Mary she had several misaligned vertebrae that needed to be realigned. He then recommended a 24-week care plan. The frequency of visits would be as follows:

• Weeks 1-2: 6 visits (3X/week)
• Weeks 3-5: 6 visits (2X/week)
• Weeks 6-24: 19 visits (1X/week)

Mary left the chiropractic office eager to fix her spinal condition. When she got to work that morning, she told her friend Anne about the experience. Having received chiropractic care in the past, Anne thought that 31 visits over 6 months seemed rather extensive. She asked how much it was going to cost Mary to receive that many treatments.

Mary assumed the whole program would be covered since the receptionist told her they accepted her insurance. Being the company accountant, Anne mentally tabulated the cost. “Mary, the insurance plan we have from work has a $30 co-pay. That means you’ll have to pay $30 at least 31 times… That’s over $900!”

Mary’s desire to use health insurance is perfectly natural… People are so used to seeing eye-popping medical bills (E.R. visits, lab tests, diagnostic images, etc) that they assume chiropractic visits are going to be just as expensive. Asking the “Do you accept my insurance?” question has become habitual in our society.

People are much less familiar with the fact that they can get starkly contrasting treatment recommendations between two chiropractic offices.

One office may recommend 31 visits over 24 weeks, while another may recommend 6 visits over 12 weeks. Office #3 might “require” 52 visits over a year, yet Office #4 adjusts anyone who walks in off the street and doesn’t even have scheduled appointments!

The purpose of this post isn’t to question or disparage the advice or quality of care offered by any particular chiropractor. Instead, my aim is to shed light on the average patient’s slavish dependency on health insurance.

When it comes to chiropractic care, consumers could greatly benefit from weighing factors besides their network. Time-commitment, deductible, and co-pay are additional elements that need to be considered when deciding between in/out-of-network doctors.

It may seem counterintuitive, but sometimes using your insurance can cost a lot more than paying out of pocket!

The knee-jerk response to this question is “the patient.” But there’s more than just a buyer and a seller in the business of healthcare.

You see, while the patient is a buyer, to whom are they really buying from? When they’re dependent upon their health insurance card, the seller isn’t their doctor… it’s their insurance provider (IP).

The doctor certainly provides a service, but not just for the patient… it’s also for the patient’s insurance company. The question you have to ask is who are they really aiming to please?

If you still think it’s the patient, think again. Sure, they want their patients to get the desired result, but at the end of the day (or in this case, the end of the month) when it’s time to pay their overhead, mortgage, and BMW payment, the insurance company mails the check, not the patient.

Regardless of how happy you are with your results, if the doctor doesn’t satisfy the insurance company (by way of billing & diagnostic codes), he doesn’t get paid. So… is his focus more on them or you?

Let’s recap. You pay the insurance company… in turn, the insurance company tells you they’ll cover the bills. The insurance company pays the doctor for some of it, and while you may be responsible for paying a portion, it’s tempting for the doctor to be more focused on “what gets me paid?” rather than “what gets them well?”

When you think about it, health insurance companies should be at our beck and call. But instead of “the customer is always right,” to them it’s “the customer is always wrong.” Patients’ requests for more treatment options get denied. Medical practitioners’ requests for higher compensation also get denied.

Instead, all we really get from these companies is big fat one of these.

All the more reason for you to take back control and pay for the services you want out of pocket. It’s a sure-fire way to get the care you need and deserve.

A lot of people want chiropractic care, but only if it’s covered by insurance. Some people have it made up in their minds that they will only go to doctors who accept their particular plan… so it should come as no surprise how often chiropractors hear the question, “Do you accept my insurance?”

Using insurance for visits to your medical doctor can be different than using it for visits to your chiropractor though. In fact, you might be surprised to find out the true cost of insurance when we run the numbers.

A good friend of mine is a very successful “full spine” chiropractor who I’ve known for about nine years. Recently we discussed how much he dislikes accepting insurance, and how long it can take for him to get paid.

He said that every year insurance companies find ways to reduce reimbursement amounts, and that patient co-pays are getting higher. The average co-pay in his office is $30; it used to be $15. More and more of his patients have co-pays exceeding $40! He feels that when the average co-pay becomes $45, it will no longer be worth his time and effort to participate.

During our conversation, I asked my “full spine” friend how many times he sees the average new patient within eight weeks. Without delay he quickly said, “20-24 times.”

Let’s split the difference and say 22 times. If his figures are correct, then the average patient coughs up a $30 co-pay during each of their 22 visits… Over the course of eight weeks, the “out of pocket” expense for visiting my chiropractic colleague who “accepts insurance” would be $660.

When he asked me the same question, I told him that it depends entirely upon the patient, but ranges anywhere from 2-8 visits. Splitting the difference, their out of pocket expense for five visits is $375 (not to mention the reimbursement they get with out-of-network benefits, which could make this as much as $250 cheaper!)

Now, I’m not suggesting that one method of chiropractic is superior to another… But the average patient doesn’t realize that the number of visits in one type of chiropractic office could be as much as 3-10x less than another.

And we can’t forget the time factor… How much time is required to make 22 trips to the chiropractor? If the average visit takes 10-minutes, it’s 220 minutes, excluding round-trip commute. What’s 3.7 hours of your time worth?

If that wasn’t enough, the more often you make use of your insurance, the higher next year’s premium will be… You might be paying $130 per month for insurance in 2009, but if you use it 20-24 times, chances are you’ll be paying more in 2010.

So the question that patients ultimately need to be asking isn’t, “Do you accept my insurance,” but more importantly, “Is using my insurance really worth it?”

Imagine what would happen if health insurance companies ran the educational system…

When it came time to send your child to elementary school, the insurance company would make you pay for something out of pocket first; in this case, Kindergarten. Just pay that deductible, and let them handle the rest!

Whoa, not so fast… They’ll only cover what’s considered “usual, customary, reasonable, and necessary.” According to your policy, they will pay for 75% of elementary school… which is only 1st-6th Grade. That means you’re responsible for 7th and 8th.

When it comes time for high school, they’re even less generous. See, the insurance company doesn’t like having to pay for more than it absolutely has to… and they actually employ persnickety statisticians to analyze and compute numerical data that determines what is “reasonable and necessary.” In this case, they’ll cover basic courses like Algebra, History, and Remedial English, but if you want Calculus, English Lit, Physics, or PE, that’s gonna cost ya.

Suppose you’d like to apply to a few colleges… You’ll need to take the ACT and SAT for that, but the prep course and actual tests will again be your responsibility. And speaking of college, that level of education could be considered “unusual, uncustomary, unreasonable and unnecessary,” so you definitely wouldn’t be getting any assistance there.

While this analogy may seem silly, I have to wonder how many people would skip 7th & 8th Grade because they had to pay for it out-of-pocket? How many would leave out the “non-covered” subjects in high school?

Fortunately, our educational system doesn’t operate this way… but sadly, health insurance companies do! The health care system is nothing more than a business. Their clients (you and me) are liabilities, not assets.

Now, it’s a no-brainer that some form of insurance coverage is necessary. One night in the emergency room followed by a day or two in the ICU can bankrupt a family. But some people are under the perception that the insurance company will happily cover any and all expenses, without question. As my brilliant colleague, Dr. Michael Dorausch once said, “Insurance is not a credit card for magically free health care.”

Show me an auto insurance company that pays for car washes, oil changes, windshield wipers, fuel, and servicing, and I’ll show you a health insurance company that will actually pay for all of the care you need. Neither company exists!

These companies have a financial obligation to their shareholders to make profit. The easiest way to boost revenue is by covering less and denying more of the services you want and need.

Here’s the bottom line… Health insurance companies do not have our best interests at heart. Do not depend on them, or expect much cooperation on their part. Putting your health and well-being in their hands is like relying on OJ to find the “real” killer. Never gonna happen!

This is a funny video mocking the way insurance companies do business. Worth a look.