Insurance, Inflation & Small Business Dilemmas

November 6, 2022 by Andrew Spracklin
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I’ve said this before and I will say this again, when I was in my first day of chiropractic school, Dr. Winterstein said: “Take care of your patients and your patients will take care of you.” If you go into any form of healthcare, you either go in it for the patient or you go into it for the money, most of the times it’s hard to do both and if you go in it solely for the money, boy do I have news for you.

With the current state of the world, I wanted to elaborate a little bit of the bind that healthcare providers have been put in. For most providers insurance companies set the fee schedules and you either agree to the network rates or you go out of network and become kind of a pain to the patient. We are in-network with just about every insurance company that is offered in the state of Nebraska and we don’t plan on changing that.

As you have probably noticed, the price of everything is surging at the moment and healthcare is no exception. The problem we run into, raising prices in the healthcare setting doesn’t really matter or help when you are running a healthcare business.  We are only allowed to charge the patient the allowed amount that is set by the insurance company. This most recent year, a fee cut was set across the board in all healthcare fields, a few companies kept prices steady but the bigger ones gave a fee schedule cut across most professions (chiropractic is not alone).

It doesn’t really matter if I charge a million dollars a visit, if I bill that to insurance I can only charge the patient a certain set and agreed upon amount.  Some insurance companies are easier to work with in regards to allowed amounts and some have limits that are very cumbersome, in regards to number of services that are allowed per treatment session.

This is where the hard part comes in, even if I wanted to raise prices, I can’t because insurance will only allow a certain amount per line charge and for the most part we are taking fee cuts not raises. (Think about it this way, nearly every insurance company is “for profit” and needs to show that they are making money, they are going to charge the patient more for coverage and reimburse the doctors less, it’s a novel concept that is simple to understand, but tough to break the cycle)

The crux within the profession at this time, in order to increase your bottom line which is ultimately necessary to keep up, so we can continue to stock the clinics correctly and pay help a wage that is deserving of what they do, the business needs to collect more money, not necessarily that your profit is larger but your expenses eat away at it a lot quicker.

  1. We could charge more money per visit for the care that is delivered, this sounds like a good idea but in reality, it’s not all that possible because insurance will only allow you to charge/collect so much and within your contract with the insurance company you can only give a certain percentage of a cash discount before you are breaking the contract.
  2. More patients could be seen on a daily basis. This is an obvious choice until you put it into practice, inferior care would delivered because you would not be able to spend time with patients plus you have to keep up with all of the background work (insurance & paperwork). We are always trying to build the clinics to see more people but there is an ultimate limit to this philosophy.

We don’t plan on drastically changing anything, but I just wanted to lay out the current dilemma that most providers are under at this stage. Charge more (not all that possible) or see more patients (lose the personal care that is desired). People pay a lot of money for insurance coverage and we, at our office, feel that you should be able to use it and reap the benefits of it. It’s not a fun time to run the office but we will continue to treat patients fair and honest and give the best possible care we can provide.

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Providing effective natural chiropractic care to the Kearney Community.

Copyright by Spracklin Chiropractic 2019.