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Let's Talk Insurance

I hear it all the time, “Do you take my insurance?” And everytime I hear it I sigh a little. I definitely want to help you out as much as possible and make your care as reasonable and affordable as can be. And It’s a perfectly reasonable questions for you to ask, so my typical answer is, “I can check your benefits and let you know.” But health insurance companies don't really cover health care. They cover sick care.

We need to start thinking about “Health” insurance as being more like “Sick” insurance. It’s there for you when something goes wrong. Not when something goes right. It doesn't necessarily help you when you are trying to be preventative or maintain a healthy lifestyle. Which is the core fundamentals of what Chiropractic is all about. We care about prevention, functioning as well as you can be, and living life at 100%. Wouldn’t it be great if health insurance actually covered the things that we use/do to stay healthy like organic food, gym memberships, massage, acupuncture, vitamins and supplements, and Chiropractic care! And yes, I know, some insurance plans do cover a few of these things but usually it comes with a pretty steep deductible and/or really high copays.

Let me give you an example: I had a new patient come in for her initial exam and ask if we could check her insurance benefits, which of course we will gladly do. She was pretty sure she had some chiropractic benefits but she wasn’t sure exactly what they were. When we checked, we were told by the insurance company that she had a deductible of $8,000 and she had 20 visits allowed per year at a rate of $41.15 and a copay of $40. I know to some of you this is all just a jumble of numbers so let’s break that down… in order for her benefits to kick in, we would have to meet her deductible of $8,000 in less than 20 visits. Thats crazy, I don’t and won’t charge anywhere close to $8,000 in an entire year so we won’t ever meet her deductible in time for the coverage to kick in. In addition, those 20 visits start as of day 1. So we would have to charge and bill over $400 per visit (which is impossible if they only allow $41.15 per visit) for those 20 visits to even reach $8,000! Then to just top it all off, the insurance company allows $41.15 to be billed and the patient has to pay $40 of that, leaving the insurance company responsible to pay a whole $1.15 per visit, which in actuality will never be paid out due to the fact that we will most likely never reach her high deductible. So when she was told that Chiropractic care was a covered benefit on her health insurance plan, were they telling the truth? Yes, but they definitely didn’t explain to her all the fine print.

So what do we do about it? Well in my opinion, I much prefer to leave insurance companies alone and kindly ask they do the same for me. I set my fees to be reasonable and affordable without billing health insurance. In fact, my plans are usually more affordable than if someone were to use their insurance elsewhere. In avoiding the billing I can save on overhead costs by not hiring a billing manager or third party. I can keep my fees affordable for patients when I'm not chasing down checks for $1.15. The absolute best part is I get to focus on the person on the table in front of me and not look at them like a dollar sign (and definitely not a $1.15 dollar sign)! I can stay tuned into what they really need and not what their insurance dictates. To me, that's what integrity means. For more info on chiropractic plans and payment information feel free to contact me at or call me at (253) 722-6150.

In love and health,

Dr. Jes

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