Our topic today is whether you have Health Insurance or Sickness Insurance.
The question is when do you really use your insurance? Is it when you’re healthy or when you are sick?
Most of us are going to answer “when you’re sick, of course.”
When you have a problem or some sort of symptom is when you’re going to use your insurance. That’s when they will pay.
We should get out of our minds that our health insurance is going to bring us health. It is really there as first aid or when your body breaks down.
This brings me to another situation which just happened today. There are two sickness insurances called Health Care and Pacific Care who has contracted a manage care company called Optimal Health. The purpose of a manage care company is to not allow you to utilize your benefits.
For example, I was interviewed by the Optimal Health manage care doctor who was looking at my cases of patients who had said insurances. According to the national average, most people were going to the chiropractor an average of 8 times, where mine was an average of 12 times. He told me I was over-utilizing this type of care; however, if we look back at where they get their averages it stems from when the insurance companies had specific procedures implemented on the doctors. Forms had to be filled out with specific information on the care plans for the patient. They would then determine whether they would accept the recommended amount of care for certain conditions.
I would put down what was more accurate for the patient to get over their symptoms. For example, I would put down 20 visits for symptomatic relief NOT corrective care, and ALWAYS get rejected. This was before they had their national averages, by the way.
I would call other doctors and they would have the same problem, until I found one doctor who told me to send it in for 12 visits and then try to ask for more later. That way the patient could at least receive some Chiropractic Care, otherwise the patient wasn’t going to get any care. Once the doctors found out a way for their patients to receive some chiropractic benefits from their insurance, they started to recommend less visits. Unfortunately, the insurance companies developed a profile and would use that to back up statements of over-utilization violations. It’s a strong arm method, a sneaky method utilized by insurance companies so to not have to pay for care.
What we should realize is that the manage care system is not designed to allow you to utilize your benefits. Your best bet would be to get together and try to fire the manage care system that is not here for your best interest.
If you have questions about this, don’t hesitate in asking. I just brushed across one of the many thing we, as doctors, have to deal with when dealing with insurance companies. Unfortunately, our hands are tied, as doctors, when insurance companies manipulate statistics in order to justify their utilization of care.
Just a reminder, in our office we practice corrective care not acute care. So, insurance companies will pay for acute care and not full correction. Once those visits are up, however many they are, it will be up to you to shift into corrective mode. If you have any questions about that, do realize our fees are 30 – 50% less than chiropractors in our area, to allow you to get the care you need.
Any other questions, ask us here @ Bates Chiropractic!