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Patients with Bad Insurance

Problems with patients not accepting care because of insurance?

Although there is no magic bullet for dealing with people not accepting care because their insurance does not cover it, there are a series of things you can do to help.

1. Separate the bad news from the doctor

a. When setting the appointment "We will do a complimentary benefits check of your insurance so when you get here we will know if and what your insurance covers."

b. When the patient arrives go over their insurance with them right after they fill out the history form before they meet for the pre-consult or consultation.

c. There are four possibilities

i. They have insurance that covers a lot

ii. They have insurance that does not cover a lot

iii. They have insurance that does not cover you

iv. They do not have insurance

d. Greg Stanley recommends that your CA has a binder of all insurances several in each category. I.e. Blue Cross is a category and have 5-10 EOB's showing what they normally cover. Of course black out personal information like names and account numbers. We want to be able to show them what their insurance is really going to cover vs. what they believe it is going to cover. The reason we want to discuss it before the doctor meets with them is because coming into this they don't think they need much care. If they hear that their insurance sucks they are o.k. with it because they don't really think it is going to be much any way. Also we do not want them getting to the ROF thinking their insurance is going to cover everything only to have the doctor show them what they really need and that their insurance is not going to cover much. Cialdini lets us know we want to separate the bad news from us. It is easy day one to show them their insurance sucks, everyone hates their insurance company... that is where their dislikes need to stay... we do not want them disliking the doctor or this office because of how bad their insurance is!

e. CA goes through their insurance with them:

i. They have insurance that covers a lot - "Great news"

ii. They have insurance that does not cover a lot - "Although your insurance company may say they cover a lot I just want to show you the last 5 people who came in with your insurance. Your insurance company denies services within the first 6 visits." Let them get angry at their insurance company... not us! "Luckily all 5 of these people got on one of our patient friendly financial plans and they are getting the care they need. The reality is most of our practice is cash so we have very affordable plans."

iii. They have insurance that does not cover you - This is the rough one. All we can do is let them know is we are not in network or whatever the case is AND we have several long term families who also have that plan but choose to see us because of the great results and reasonable plans we have. If it is true help them see how with your cash plans vs. how little their insurance covers and how much care most people need it really is going to be cheaper or around the same price here. If that is not the truth DO NOT LIE!!! Just let them know what makes you special here and let them know that most people are happy to pay for these extra benefits i.e. technique of doc, or certifications etc. If they say they really would rather see someone in network bless their heart, send them on their way, let them know you are here for them if they need you and save the entire team processing an patient who would not have signed up no matter what you did!!

iv. They do not have insurance- Great, most of our practice pays cash just like you. We have very affordable patient friendly cash plans

2. If they either have bad insurance the doctor needs to point out during the TTAT portion of the examination that this really is more of a health problem than a back problem and there seems to be more than meets the eye, (of course assuming that is the case.) This begins to prepare them that they might need more care than they originally thought. The doc can let them know that next time we meet I will give you recommendations. We will look at what it takes to reach optimal health where you not only feel better but we really correct the underlying cause of the problem and prevent problems in the future as well as have a better quality of life as well as what they may want to do to just feel better. They need to know that their insurance company is not responsible to help you towards optimal health. Their only responsibility is to pay for enough care to get you feeling some better and the truth is this particular company hardly does that! Of course we are pre-paving the way so they will not be shocked when we give them recommendations next time. When giving the treatment plan recommendations during the ROF you need to make sure they really understand the difference between what they need and what their insurance covers. A great question to ask is, "Do you want me to give you recommendations as to what you need to get healthy or what your insurance company will pay?" Then you need to help them understand the difference between acute care, chronic care, health care etc.

3. Discuss with the patient specific things that make you different. What makes you special? Your technique? Your special ratings or licenses? Wellness vs. pain care? Technologies you use? You may discuss why you are not a provider in their specific plan etc.

4. Don't kid yourself. No matter how good you get at this some people simply will not pay for health care. They believe their insurance should pay and they will not change their minds about this. Remember the four letter word... NEXT!

5. I asked Dr. Troy Dukowitz (a wonderful coach) how he deals with such problems and here is what he said, "Joan, I have some great news... your insurance does not cover in our office." Of course, Joan is now confused. "Here is what I have found. Normally, an insurance will cover about 10 -20 visits for you to see your chiropractor. They do this without knowledge of your scans, your x-rays, or your health. So they guess with your health. What I am recommending today is a way for you to benefit the most from chiropractic by giving you recommendations based on my findings. The decision is ultimately yours to let insurance run the game, or for you to take charge of your life and your health." I like it. Another version of that I also like a lot is, "Joan, before I give you my recommendations I need to ask you, do you want me to give you my recommendations as to what you will need to do to get healthy or do you want me to just tell you what your insurance will cover?"

Although there is no 100% fix to this problem I do believe if you take the above steps you will get much better results.

Russ Rosen, D.C. - Oct 21, 2007