Monday Morning Motivation | Lie #3 - Insurance

Posted by Bill Esteb on Jun 14th 2020

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Lie #3: If I conform my practice to insurance carriers I'll see success.

Actually, many of the challenges facing chiropractic today are due to the unhealthy influence of so-called "insurance equality." Which can be traced to October 30, 1973 when President Nixon signed the legislation including chiropractic in Medicare.

What was celebrated as a huge win for patients and the "acceptance" of chiropractic has contributed to reducing the profession to the low-tech, drug-free treatment of neuromuscular-skeletal complaints. And not being able to opt out has been a philosophical leash defining chiropractic that has been used to constrain the profession.

Just a generation before, chiropractic was a family-based, whole-body health discipline. As chiropractic was forced to adapt to the medical philosophy and relegated to treating named spinal conditions, the original principles of chiropractic became obscured and practically disappeared as old timers retired.

No matter. The money was pouring in and many chiropractors became quite affluent by learning how to tap the reimbursement of insurance policies. Many policies demanded mere $100 deductibles and required little or no documentation. The Mercedes Eighties was an amazing time in chiropractic. Many thought it would propel chiropractic to respectability and last forever.

It did neither.

Many practices have been left at the high tide watermark, baking in the sun as reimbursement receded and replaced with burdensome documentation and the looming threat of a post-review audit.

So profitable was this gold mine, practices could afford to hire staff to process the claims and take insurance "assignment." This produced several unhelpful effects. The first being that patients came to expect their policy would cover all the care they would need.

The second being that the unique language of chiropractic was drummed out of the profession in favor of sprains, strains, spinal dysfunction and manipulation.

The third being that with the financial component no longer creating new patient friction, a chiropractor's ability to explain chiropractic and introduce its principles to strangers in a compelling way, began to atrophy.

While it took two generations to accomplish, the insurance industry has taken over the economics of many chiropractic practices. The purpose of the AMA's Committee on Quackery to "contain and eliminate" chiropractic appears to be progressing, albeit more slowly than was hoped.

This has caused many practices to base their financial futures in the hands of a half dozen insurance carriers rather than hundreds of direct relationships with individual patients. This is precarious and increasingly unnecessary. Especially as more and more patients have deductible amounts to fulfill that are far greater than the typical case average.

These days most insurance policies are designed for catastrophic health issues; cancer, diabetes, etc. A bout of back pain hardly rises to importance within a system already over burdened.

Of course, the way out of this bondage is to stop taking insurance assignment. "I wish I'd done it sooner," is a common refrain from among those who are no longer slaves to this corporate concern. It's best to do this over the course of six to nine months so you don't put your practice into shock. It may require getting your own financial house in order first, but I know of no one who left the clutches of this parasitic industry and later went back to the onerous documentation, claims cutting, audits and foot dragging. But you always can if the freedom is too scary.

Truth: Insurance carriers aren't interested in their policyholder's health and especially your focus on health and prevention. The insurance industry is little more than a middlemen, profiting from the arbitrage between ever escalating premiums and reduced provider reimbursement. You lose by agreeing to play.


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Bill Esteb has been a chiropractic patient and advocate since 1981. He is the creative director of Patient Media and the co-founder of Perfect Patients. He’s been a regular speaker at Parker Seminars and other chiropractic gatherings since 1985. He is the author of 12 books that explore the doctor/patient relationship from a patient’s point of view. His chiropractic blog, in-office consultations, patient focus groups and consulting calls have helped hundreds of chiropractors around the world. His Monday Morning Motivation is emailed to over 10,000 subscribers each week.