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 members whose patients 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 people 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 4 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.

DCs have long been challenged to find a way to offer affordable care to the underinsured and uninsured patients. But it’s likely that this is the first year that even patients who may have considered themselves to be well-insured are finding out that they may NEVER meet their 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 DCs recommend care to their patients, it’s only natural that those patients 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—doctors are 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 the doctor’s actual fee, which is likely somewhere between $90 and $120. And that is what they assume they’ll have to pay.

ChiroHealthUSA is a network that works in conjunction with a Discount Medical Plan Organization. And, it can be used by patients with these crazy high deductibles and copayments. Under this agreement, patients have the ability to opt-out of filing their health insurance, but only if it’s done properly, and this does NOT apply to Medicare beneficiaries. Membership in ChiroHealthUSA for the entire family is only $49.00 a year —an affordable cost often recovered on the first patient visit.  ChiroHealthUSA also offers your member doctors a compliant way to offer any and all of their patients a capped, discounted fee without the risks of offering dual fee schedules or improper time of service discounts. Imagine how thrilled your members would be to be able to offer these patients an option 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 a year, —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 about the same amount—or maybe a little less—than your insurance copay. Would you like to do that?”

Can you truly imagine many patients saying no? In fact, it’s likely that if their deductibles or co-pays are high enough, they may wish to just start with ChiroHealthUSA in the first place and disregard their ridiculous insurers altogether. It’s all about offering options these days and ChiroHealthUSA is the PERFECT option for over 3,000 practices and over 300,000 patients!

Help your members stay in compliance and still give their patients a workaround for their insanely high deductibles by suggesting they become a ChiroHealthUSA provider. Urge your members to find out more by checking out our information-packed short videos on how we can help doctors grow and protect their practices at chirohealthusa.com.