As the year turns over and people start to present into offices with different insurance cards, I wanted to do a brief write up on Medicare Advantage Plans, why patients love them and offices/physicians loath them.

When you turn 65 you get the option as to what kind of Medicare you can sign up for, Traditional Medicare in which you have a deductible of around $250 and then pay 20% of the allowed amount unless you take out a supplemental plan, which most people do.  This is the bulk of your cost is the cost of the premiums on a month to month basis but not a lot of questions are asked about treatment, you get the care that needs to be done.

Medicare Advantage plans are when the patient essentially gives up their traditional Medicare rights and allows a private insurance control the plan. It is much more like what we see in our office as a traditional insurance.  The premium is typically lower, the coverage normally included prescription, dental & vision but the initial burden falls on the patients. A deductible needs to be met, co-pays are normally required at office visits and we have begun to see a trend towards pre-authorization for care.

From a chiropractic perspective, this can be a nightmare for certain plans. As with traditional Medicare, only the adjustment is covered.  Medicare does not cover therapies and exams in a chiropractic office, we can bill for them but the responsibility falls to the patient. The fee schedule for Medicare is stagnant if not declining. So, when someone says you should just raise your price to come in, it doesn’t necessarily work like that, when we agree to accept Medicare patients we are agreeing to a fee schedule and the rules that Medicare sets out, we can’t just “charge more.”

Let me paint you a little picture: a patient presents at the first of the year and gives us a new insurance card; it’s a Medicare Advantage Plan. We bring you back and treat you like you were before the patient selected this particular insurance. When the patient leaves, is when the work actually starts. I, the doctor, sits down at a computer, logs into a website and requests care from a third party conglomerate, which requires constant oversight as we have numerous patients we are watching how much care is allowed and when certain authorizations expire. We may get 10 visits over the first 2 months.  The patient will get a bill for their co-pay amount for each visit. A phone call comes in, it’s the patient saying, why do I owe this amount, it’s the plan you signed up for.

On a side note, this is actually one of the worst parts of the entire process, is that we (the office) have to explain benefits to people (not our job).  The agents that are signing people up for these plans don’t do a good job explaining what is and isn’t covered and what the expectation level will be on the patient end when they present the card to an office.

The first authorization is not normally an issue, it’s the second and third….the “incidents” are not taken into account individually. Let’s say you come in 4 months later, they may only authorize 4 visits over 8 weeks. The year is looked at as a whole, not on an incident by incident explanation.  They are trying to manage cost, for every visit they can “not allow” the more money they save and adds to the bottom line. The more times you try to get pre-authorization, the fewer visits that will be allowed if not flat out denied in some cases.

The plan that you sign up for has a trade off for the cheap premium, which is why most patients love them.  You are responsible for more out-of-pocket expenses, while the doctor and office has to do more background work and paperwork with 3^rd party companies that are going to dictate how much care you are “allowed.” I’m not saying that insurance is perfect, all of them have their quirks and intricacies but the Medicare Advantage plans are crazy in our office because most of the time we are doing paperwork and notes to collect somewhere between $6-15.

While it’s not necessarily in our game plan, don’t be surprised when clinics, hospitals and doctors stop accepting certain plans. We have seen certain hospitals having to hire additional staff just to “babysit” the pre-authorization process while not getting reimbursed more. So try running an office or a business, where you are required to perform more work, can’t raise your prices and your cost of operating a business continues to rise. The math doesn’t math in most offices. There is no perfect solution when it comes to healthcare but the current model doesn’t seem to be working for anyone other than the insurance companies.

I normally try to sit down at the end of the year and put together some thoughts about the previous year and reflect on the things that went well, went bad and what we can change in the office to make it more convenient and accessible to everyone that comes in the doors. I’m taking a few days off to gather some sanity and thoughts so I’m going to do some writing.

2024 was largely an unremarkable year; we saw lots of changes in regards to Medicare Advantage plans and some insurance in general. In all honesty, it was a pretty stagnate year which I think if you talk to most business owners, they would largely agree.  There is no real rhyme or reason why it was but it just was. (Think pre-authorization process for the doctor with lots more documentation requests all while taking longer for claims to get paid/processed)

We made a push and will continue to push to grow the DOT side of the business.  Hundreds of DOT physicals were performed this year and we would like to continue to see that number grow.  Drug and alcohol testing is growing as well.  Our consortium continues to add more and more members that trust us to keep everyone in line with FMCSA/DOT drug and alcohol standards.

From a chiropractic perspective, we saw LOTS of patients of all ages and demographics. Different conditions come into the offices regularly.  It’s not uncommon to hit just about every complaint in a day, from a headache, sciatica and elbow pain, sometimes all in one patient. We can handle lots of conditions but we do have our favorites and are comfortable with.

Patients seem to like the laid back atmosphere of our offices and quite honestly, I do too but we go into the new year I’m going to be making a push to see more follow up visits.  While that doesn’t mean that long, drawn out treatment plans are going to be coming in, we are going to try to make a more conscious effort to track patient progress a little closer.

I would also like to make the point, that we are a business that has bills to pay and people to pay, so while we field a lot of comments that I must just be raking it in because I’m a “doctor.” If it only worked like that, raising prices doesn’t work that well because you are beholden to insurance contracts and still need to be competitive in the market. It’s not my favorite topic to broach with patients, sometimes the hard conversation needs to be had about insurance coverage, cost per visit and how we as an office did not select the plan that you selected whether it be on the marketplace or through your employer.

2024 was not a bad year by any means but it was just interesting.  I’m hoping that 2025 continues the trajectory that we have set out on over the past few years and the ups and downs that come along with owning a business, but reflection and fixing certain situations most certainly project that 2025 should be a better year than 2024.

We look forward to seeing everyone in the new year after a few days off to gather some thoughts, rest and sanity.

It all started with what I thought was a stomach bug.  I left work early, didn’t feel all that well, couldn’t make it to work the next morning and ended up in the Emergency Room.  A little while later, I find out I have a ruptured appendix and am septic in the ER. Surgery ensues, which went according to plan, drains are in place and IV antibiotics are my new normal for the 5 days I spend in the hospital.  Peritonitis (infection/inflammation of the abdomen) and organ systems that had started to shut down needed to come back on line. Released from the hospital and spend 7 days recovering at home while trying to not go crazy, get depressed and maintain a normal household with a 6 & 4 year old.

I had no idea what life was going to hand me when I left the office that day thinking I just had a stomach bug but at the end of the day, you have to be able to control what you can control and this situation spun out of my control in a hurry. My wife indicated that she had never seen me more at peace with not being at work, in this situation I had no choice.  I couldn’t get up and leave and miraculously start working again.

Being self employed and essentially having the business rely on you, the doctor, to be present to generate revenue creates a caveat when you are out for an extended period of time. While we are not in jeopardy of going out of business, finances take a hit when no one comes in the door for 2 weeks.  The headache of having other people in the office is not worth it at this time for me, so I end up just taking the hit and moving on.

Follow up appointments have all finished up and we are getting back in the swing of things at this time. This is currently our third week back and while I was hoping to be it would be a little bit of a slower build back into practice, it was not.  The past couple of weeks have been slammed and honestly, my abdomen and health suffered the consequences fairly regularly. At the end of the day, I have been very fatigued, sore and zapped on energy.  The general rule of thumb is for every day in the hospital it takes 4-7 days to recover.

The stress points of running a solo practice came to surface.  While Marty and Carol are seriously my Godsends, they can only do so much.  Phone calls and billing were what kept them busy and I cannot thank them enough. When you are out for an extended period, patients understand the circumstances and are very gracious but there were a few that exposed true colors when complaining about how long I had been out and billing/collection issues that patients can be downright rude about.

I truly appreciate all the thoughts and prayers that came my way over the past few weeks, we are beginning to get back to a normal flow and hope to keep it that way for a while. The end of the year is always a little hectic but this one will be a year to remember, with my own personal health scare.

In ending, just know that sometimes I’m not in the office it could be for professional reasons, health reasons and on the very rare case, personal reasons.  As the calendar turns over, I’m going to try to take few days for my own enjoyment as two week off was not exactly enjoyment.

Always remember, that life does come at you fast and try to enjoy it as it goes because it can go sideways in a hurry.  The situation ended well and I never felt in jeopardy but I was a VERY sick boy and am forever grateful to the doctors and staff at CHI Good Samaritan.

The current state of Chiropractic, in my opinion, is on a cusp. This might just be my observation but it’s what I actually see on a daily basis. The profession is ever evolving and appears to be going more to a rehab/functional medicine model. Outside of prescription rights, there are not a lot of limits on the scope of practice within the chiropractic profession. While I don’t want anyone to limit our scope of practice, it is my thought process that some offices take this to a new level. The comingling of providers skews this practice quite a bit because you as the patient may not even know the what type of provider they are seeing, physical therapist, occupational therapist, nurse practitioner or chiropractor….while all in the same office the flow may never been known by the patient but from a billing and licensing prospective, they are all different.

There to be a time and place for multidisciplinary offices, it is of my opinion, that patients do not want to be served a platter of services when presenting to a chiropractic office for pain in the lower back or neck, they want to get better as fast as they can and come back when it happens again.  I’m totally aware of the premise of maintenance care and life long treatment, I just don’t prescribe to it. There is still a vast array of people in this world and community that wants to present to a chiropractic office for a quality adjustment, trusted therapies and not spend an hour in the office. There is a time and place for the extensive rehab, but not everyone needs or is looking for that.

One major crux in healthcare is the insurance industry. It may be the greatest curse and biggest blessing to the profession as a whole. It’s absolutely awesome that chiropractic is included in the vast majority of major health insurance plans; the downside is that insurance is essentially sick care. There is no incentive to get a patient better faster and not see them, the provider that essentially abuses the insurance reimbursement and the “system” will make more money, bill for more services, have more headaches and have very little incentive to get patients out of pain as soon as possible.

Different services are covered by different insurances. Physical therapists are reimbursed at a higher rate for certain services while both professions can provide the same service; I’m not saying this is right or wrong. Medicare doesn’t even reimburse for an initial exam but more private insurances do. If you get an injection from a nurse practitioner that works in a chiropractic office, this may be a cash service or a covered service but offices are normally set up in such a way to maximize reimbursement. Read an EOB some time from your insurance company, it doesn’t usually matter what the provider charges, the insurance dictates what is and isn’t covered. Even in our office, there are certain things that certain insurances don’t cover, it’s not our responsibility to know your insurance coverage, we submit the insurance claim and hope for the best with the information that is provided to us by the patient.

Personal research and development can pay huge dividends for offices, while it’s always a learning experience, it also teaches you what things work and what doesn’t. We have tried traction tables and lasers. I’m a terrible sales person and most patients don’t seem to have interest in these types of therapies. I’ve come to learn that the tried and true techniques and therapies are what the vast majority of my patients want and appreciate. Sure, I fell into the DOT realm and like it as a niche part of my practice and having acupuncture available is beneficial but outside of that we keep things VERY simple in our office and feel that most people appreciate that. I’ve said this before and I will continue to say this: our office is not for everyone but we will give it our all for those individuals that find value in our services.

Slightly different tangent, but students are coming out of school with MASSIVE student loans and the traditional model of chiropractic is not conducive to high profit margins that are needed to pay your bills and live a comfortable life. Insurance dictates a lot of things in the healthcare realm and the only solution for reimbursement is to see more people.  If you are not capable of seeing more people you tend to lean towards providing more cash based services and longer treatment plans in order to maximize the insurance and patient dollars. While we may be old school in our treatment techniques, we have positioned ourselves well for the future by delivering a quality product at an affordable price. Are we the cheapest, I’m not sure and are we the most expensive, not by a long shot. But I do try to live by the motto: I’m able to sleep soundly at night with how the practice is run. The profession and my own practice drive me crazy from time to time but ultimately I’m happy with where things are.

While this may just be my personal opinion and not do anything long term but it’s a reminders that we attempt to provide quality, honest care with good people to help you feel better as fast as we can with no long term time or financial commitment. In ending, what is chiropractic anymore, I know what I would like it to look like but I’m starting to think that my type of practice is a dying breed as they are not huge profits driven. I’ll survive and thrive (hopefully) but the profession is ever evolving and there are a lot of factors at play, but the chiropractic profession will look different in 20 years then it does today, I will promise you that.

Over the course of the past 2-3 years, my wife and I have become personal finance gurus. We have paid off student loans and tried to set up ourselves and our family up for many years to come, while this is not an instant results endeavor but small steps can make a big impact. Part of the process of investing is compounding, where your initial money and investments start to make gains on the early work.

One of the major parts that people don’t like about investing is the ability to mentally withstand the ups and downs of the market. Your 12% gain on average is not a smooth path; you could see a 20% loss or gain on any given year. So you have to be able to stomach the volatility.  Most financial advice  indicates that the major index funds are self cleansing, the top 500 companies in the US will be an ever evolving thing, companies will come and go. So you don’t necessarily have to choose individual stocks, you can choose the broad index and catch the majority of the gains that the market puts out, but you have to be able to stomach the roller coaster.

The art of running a business is a lot like investing. Days, weeks, months and even years have their ups and downs but I’m banking on the fact that compounding in business will also be the same.  We have been performing chiropractic care, DOT Physicals and most recently drug/alcohol testing for the last 12 plus years. Financially this has been a weird year, not that it has been bad but just strange on the collection and billing end.

Healthcare is a changing and ever evolving profession, not just for chiropractors. The market will eventually figure itself out, while we as a profession may not like the path we will get to a stable point again. Longevity should be beneficial if you are able to work through the ups and downs. The adage is that time in the market will outweigh timing the market, so you may come into the profession at just the right time and your experience will look entirely different than someone that has been on the job for decades.

The amount of goodwill and benefit of having people through the door for the past decade along with offering a variety of services (I’m hoping) should be beneficial in the long run.  DOT Physicals are a prime example, we have a strong base built and hope to build the drug/alcohol testing along with continued growth of the physical side of things.

There is another saying that comes to mind, “Comparison is the Theft of Joy,” so when a young chiropractor comes out of school and looks into starting into the profession, just know that your experience will look entirely different than your peers, so don’t try to compare yourself to others in the profession or even healthcare in general. The time you come into the profession, the demographic of patients that you see and the state you work in, will all have an impact as to how see the profession and your future.

In short, I’m banking on the fact that business, like investing will go through ebbs and flows that may not be fun or comfortable but the light and path should be worth it. Let your valuable patients and services carry you through the hard times, compounding gains along the way throughout the years. And lastly, do not compare yourself to other people in the profession because based on the time that they came into the profession and length they have been in practice the perception will be completely different.

I wanted to have a little post/discussion of some of the things that happen on a daily basis in the office that most people don’t understand or think about when they come in for a visit. I recently received an email from FMCSA (Federal Motor Carriers Safety Administration) that they will be doing random audits on medical examiners that perform DOT physicals.  We have also seen an increase in insurance audits and preauthorization requests from companies themselves.

This type of screening scares the hell out of providers, even if you feel that you are doing things correctly and ethically. The last thing any business wants to have is to open up their records with the possibility of money claw backs and threats of taking away the ability to perform specific tasks within the office.

The question arises all the time, “how come you only give me a one year or three month card?” Well, I don’t make the rules.  The enforcement arm is always on the back of the mind. Blood pressure medications, CPAP’s, certain types of diabetes and other past history can bump certifications all over the place. Just because you passed the test and have been performing them for 12 years, doesn’t mean that they just let you keep doing them without some oversight.  There is A LOT of wiggle room with these physicals and we feel that we perform them to the best of our ability.

The other issue that we are constantly running into, the ever evolving health insurance model, I’ve always said “I just need to know the rules to play the game but a lot of the new insurances don’t tell you the rules, you just figure them out as you go.” There are new preauthorization requirements for certain insurances and “palliative care” is starting to get cracked down on quite a bit more.

Maintenance care has never been allowed by the majority of carriers, so if you plan on coming in every two weeks on the dot or schedule a month out for your next appointment because you just “like to be adjusted,” insurance has not and will not pay for these services.  You are more than welcome to come in and be adjusted as much or as little as you would like but just know that we, as an office, are starting to look patient by patient of things that would qualify as “maintenance care” and cracking down on it ourselves to limit the possibility of audits.

Some plans allow for a certain number of visits throughout the calendar year or give you a set number of visits over a certain number of weeks, but this doesn’t necessarily mean that this is what your insurance will pay for. We do not set the limits on your plans, we submit and attempt to do the background work, we are not picking on you if you get a bill but you don’t think you should get one because you think your insurance will pay for it.

These plans are starting to be very confusing, not just for you but for our office as well. This blog post is by no means a way of discouraging but more of a reminder that we don’t set the rules for the insurance that you or your employer signs up for. By being an in-network provider, we agree to submit and essentially hope for the best.

In ending, audits within the Federal government and private insurance companies appear to be on the rise, due to overuse and blatant fraud.  We are doing the best we can to work within the guidelines that are laid out for us and we are not necessarily picking on you or your situation. We do the best we can with the rules that are set out for us.

The mind is always wondering, what if we did this and what about that.  For the most part things have not changed that much from a treatment perspective around the office over the course of the past 12 years. Busy days, slow days and everything in-between are the norm at this point. You can make changes or you can stay the same but just know that either choice is going to be hard.

Running a small business is a grind: making payroll, broken equipment, building issues, general maintenance and just the everyday ups and downs of family and work life balance. In all honesty, I’ve never really had to work for anyone in my life, every once in a while, I float the idea of just closing up shop and going to get a day job, Kristina always tells me to just shut up because I’ve never had to answer to anyone in my life and don’t know what it’s like.

Working at a 9-5 sounds like a great idea and for most people in the world, that is how they make their income. 9-5’s are also hard. The grass isn’t always greener on the other side, owning a business is a lot of risk that only the owner and family probably truly feel but working for the man is also a grind, a lot of the times it’s just that: a boring monotonous grind that most people do for the paycheck.

Paying student loans and business debt are tough. Everyone wants the instant satisfaction of seeing a $0 at the end, but it takes time. It’s hard to make a dent but if you really want to, you can make it happen. Just know that it’s a grind and the process is tough, hell it’s tough for anyone not just a late 30’s chiropractor that feels like he is making headway. I paid my student loans off roughly 5 years ago and it’s an awesome feeling. Seeing a $0 is a breath of fresh air.

Raising a family with a little bit of work life balance is tough. The guilt that arises when I close the office down in order to attend kids stuff is a little bittersweet. I’ve told myself that the benefit of being self-employed is that I can do what I want when I want and as my boys get older I will be missing more days in the office as they get more involved and into school but I do feel like I’m letting my patient down. I don’t run an emergency room so things for the most part can wait; if life or death things walk into the office we have a different problem on our hands.

Professional life is a little chaotic at times as well. Keeping up with continuing education, professional board meetings, insurance changes and fielding questions for other doctors are part of the daily/weekly routine. I come from the school of thought that if someone my age is not willing to step into these positions then who will. I can be stubborn and bullheaded; I have a vision in my mind how things should be but have to keep my mouth shut as most of the time in these settings, the my way or the highway is a terrible way to operate.

I feel like I’m reaching a stage in life where things start to get tough with time management, kids, work, running an office and trying to keep a little sanity. The thoughts that run through my mind on the slow days can be exhausting but at the end of the day I have to remind myself that this is my crazy and comparing yourself to others is worthless.

Working a 9-5 is tough, running a small business is hard, keeping up with a family is exhausting and having some semblance of sanity is few and far between but whatever direction you choose in life is hard, so just always remember: You Get to Choose Your Hard and try to embrace it along the way.

Patient come and patient go, while you are fresh into business you ponder every patient and what you did wrong. Did you say something or do something. Probably not, as the years go by you start to learn that each patient is unique and every story is slightly different.  Different needs for different people. Every office is slightly different and every treatment varies from time to time. We actually have patients that go to different offices for different complaints.

As the years go, you almost become numb to the coming and going. We are an office that offers simple, effective care. Treatment plans are not the norm, while they are necessary for some people, the majority of patients don’t have one.

Integrated offices are becoming more and more popular, you can see a nurse practitioner, chiropractor and physical therapist all in one visit. This is not who we are. We feel that each profession has it’s time and place, while we work well with other professionals we are just not in the same office. I have my own space issues, I don’t need to share it with other people at this time.

In order to get to this point in practice, it takes a lot of getting comfortable with yourself.  Being able to treat the conditions and symptoms that you are comfortable with and being consistent with them is the first step. You need to know when to fold your cards and sent the patient on to the next professional, as it may not be a good fit.

We have been performing much more acupuncture recently than we have in years, which is awesome to see. The DOT & Drug Testing continues to grow and expand. Chiropractic care ranges for kids to the elderly and continues to get busier. This is the basis to our business, no more and no less.

If you need injections, we will send you somewhere else.  If you need expansive physical therapy, there are offices that are better equipped than us. A condition walks through the door periodically and we just are at a loss, don’t try to be something that you are not.  Guide people and talk to people, you can get a pretty good feel as to if the patient is going to get results after a treatment or two.

Being comfortable is the ability to say “I can’t help” or “I don’t have an answer for you” is a very powerful tool.  Trust me, I can BS with the best of them but your practice will build a reputation if you are comfortable with the patients that walk through the door and know what you are.

Part of being comfortable, is knowing in the back of your mind that you cannot be the end all be all to everyone that walks in the door. Having the ability to fold your cards is beneficial in most walks.

In ending, you can’t be everything to everyone and as soon as you get to that conclusion you will lead a much more sane and happy practice and life. You can try to draw as many people as you want into your practice but just know that people will leave and they may come back but be who you are and always tell the truth.

A little story, roughly 12 years ago I took a class about possibility performing DOT physicals.  At the time, I was more or less in need of continuing education and I was always fascinated with physical exams.  When I went to school I was always in love with evaluation and management of cases, this hasn’t really changed but in the chiropractic realm your vision can get pretty narrow at times. I took the class and decided to take the Medical Examiners test, passed it and was officially certified to perform DOT/CDL Physicals.

The first few years were slow and steady but every year we would do a few more physicals and that continues to be the case. But over the course of doing the exams, I would get questions about the drug and alcohol testing aspects of the Federal Motor Carriers Safety Administration (FMCSA). I was very reluctant about adding this service for a long time because who wants to collect pee for a living.

A year ago, I had a change in heart, if we are going to continue to grow the DOT/CDL physical business we might as well be a one stop shop for all things FMCSA. I took a few more classes and actually had to renew my medical examiner certificate as it had been 10 years since I took the first one. Having the ability to collect DOT drug collections and having a DOT certified breath alcohol machine has proven to be invaluable to myself and to persons that come into the office.

The breaking point is that there are not a lot of reliable offices that give companies the ability to send drivers in, essentially at their own convenience. Pre-employment and random drug testing are the major parts of the testing but there are other aspects, including return to work, reasonable suspicion or just about any other reason that your employer may want the test.

You will notice that over the course of the next two months, I’m going to get crazy aggressive in building the drug testing business. We are building our consortium, which is the third party aspect that helps run/manage a company’s drug testing program. There are certain benchmarks that need to be met in order to meet the needs of the DOT, we help guide people through that process in a relatively quick and easy way.

I’ve already said the majority of the things that I’m currently saying but what I’m going to reiterate: we love to work with local companies and will help those companies through just about any aspect of the drug testing program or consortiums. I really have no desire to manage large trucking companies, I’d love to be a collection site but to manage a company that would be described as large, this would be a little out of my realm.

So, is collecting pee a glamorous profession. I’d like to think that most people would think not, but someone has to do it and it might as well be our offices. We pride ourselves on a local, convenient option for people and companies that are looking for a one stop shop when it comes to FMCSA regulations.

Are we still learning, sure, everyone is but if you would like to be along with the ride and journey of the drug & alcohol testing, please contact us.  We’d love to talk to you and provide you the service with a smile that you deserve. The process does not need to be complicated or time consuming and this is our vow to you or your company.

We look forward to hearing from you in the future.

If someone ever wants to start a small consulting firm, I feel like this is a brain trust and is realistic but not sure how to make it profitable.

Keep offices and clinics up to date with current insurance requirements and guidelines.

Every year, we see a flood of new insurance onto the market and they seem to keep coming from every angle. Whether it is a new plan on the marketplace, a new Medicaid company or the ever expanding model of Medicare Advantage plans. Each and every one of these plans has their own caveats and intricacies.

My solution, just tell providers what they need to do. Don’t send me to a site with a library of videos that I have to sift through in order to get the information I need. Third parties are largely unhelpful and everyone needs to come into the equation understanding that insurance companies are for profit entities and if they pay money out, it is less to their bottom line.

Big to small, the last thing small clinics need is for one more thing to do but if a person was in the background that kept track of all of the updates and what needs to be placed with claims, offices, patients and insurance companies would all be happier.

We are currently experiencing a new preauthorization requirement for certain plans and another plan requires certain modifiers that others don’t require. The frustration with this is that, we don’t find out until after the fact. Rejection letters come in and the recourse is very limited because if you are in-network with the plan, they expect you to know the rules.

A 1-2 page document to show EXACTLY what needs to be done, the issue on the business side is that the document would take a few hours to put together and would be relevant for about 2 months until everyone figures out the rules. But the first quarter of every year would be the exact same because everyone is in the same boat and doesn’t know until they don’t

I know this is more of a rant but as a small office, you can start to see the direction that healthcare is going.  More and more offices are going to be offering cash discounts or just not take insurance in general because it becomes very burdensome and time consuming to not get paid (essentially not even be able to bill the patient because the claim gets denied and once a claim is denied, the patient is not responsible in many cases).

At the end of the day, accepting insurance is for the most part a game but you have to know the rules before the game starts. It’s very frustrating and confusing; honestly it can be very costly because you end up having to eat a lot of the charges. So when we ask for insurance cards at the first of the year, we are not doing it to entertain ourselves, we are trying to save everyone a little bit of headache but unless we know the rules, you can spend a lot of your day beating your head against a wall.

So in ending, a message to patients: having the correct information is key and messages to insurance companies- just tell us what we need to know. It will make everyone happier.