Is Insurance Keeping Your Patients Out?

Dr. R. A. Foxworth, FICC, MCS-P

Love it or hate it, the Affordable Care Act has changed the healthcare marketplace. For all of your patients who are now facing the high-deductible consequences of the ACA insurance plan they chose, it’s almost always “hate it.”

And with good reason. A $1,200 deductible used to be considered pretty high. But these days, it’s not unusual for patients to have deductibles that represent 5% of their incomes—or more. Poor, formerly uninsured patients are getting Medicaid through the Affordable Care Act and finally have coverage. But middle-class workers are increasingly staying away from doctors of all kinds, due to the simple fact that their deductibles are too high.

A recent Commonwealth Fund survey found that four in 10 working-age adults skipped some kind of care because of the cost, and other surveys have found much the same. The portion of workers with annual deductibles — what consumers must pay before insurance kicks in — rose from 55% eight years ago to 80% today, according to research by the Kaiser Family Foundation.

You’re ahead of the game here, in that you’re already offering your under-insured and uninsured patients discounted fees through their ChiroHealthUSA memberships. But it’s likely that this is the first year that even your patients who may have considered themselves to be well-insured are finding out that they may NEVER meet those high deductibles. And for all too many patients, the first response to “I can’t afford this” is to stop making appointments.

“We know that when people have health insurance but their deductibles, co-pays, and other costs are more than they can afford, they don’t get the care they need,” says Commonwealth Fund President David Blumenthal, M.D.

When we recommend care to patients, it’s only natural that they focus on the money: what their insurance covers, and what their copays are going to be. When those deductibles and co-pays are out of reach—and covered care may be limited to 15 visits a year—you’re essentially dealing with “cash-like” patients, no matter which company’s name is on their insurance cards.

More significantly, patients who’ve had some degree of insurance coverage have likely seen the Explanation of Benefits, and so they’ve seen your actual fee, which is likely somewhere between $90 and $120. And that is what they assume they’ll have to pay you.

ChiroHealthUSA gives you the ability and the tools to be able to say something like this:

Staff: “The doctor has recommended 30 visits for your treatment. Now, your insurance will help you pay the first 15 with a co-pay of $50 each. But on that 16th visit, our actual fees will apply, which are between $90 and $120—unless you have one of those discount medical cards. Do you have one of those?

 

Patient: “No I don’t.”

 

Staff: “Not a problem! That’s why the doctor joined ChiroHealthUSA. That’s a network you can join for only $49-it’s sort of like a Sam’s Club for healthcare. That means your visits will be capped at $45 instead of $90-$120, and that $49 fee covers you and your family for a whole year.

You can see how you’re going to make up the difference on the first visit alone! So you can continue your care for the same amount—or maybe a little less—than your insurance copay. Would you like to do that?”

Can you truly imagine many of your patients saying no? In fact, it’s likely that if their deductible or co-pays are high enough, they may wish to just start with ChiroHealthUSA in the first place and disregard their ridiculous insurers altogether by opting out of filing their insurance. They can do so with ChiroHealthUSA, but you must explain their options, have the proper forms signed, and let them choose. This does NOT apply to Medicare patients unfortunately. Details on the “Election to Self-Pay” are in your resources tab on our website.

Reach out to us any time you need help talking to your patients about their insurance and their high copays and deductibles. And be sure to check out our information-packed short videos on a variety of subjects critical to the health of your practice at chirohealthusa.com.