4 Reasons Why I Don’t Participate with Insurance Plans

Providers who participate in insurance plans have standard or published fee structures which represent the full cost of services. For the insurance plans that they participate in, those fees are negotiated to a lower rate for those patients who carry that plan. Each insurance company will negotiate different rates of payment, can negotiate set numbers of visits allowable for payment each year, and can explicitly exclude coverage for certain services within a specific demographic.

Below I’ll be sharing the reasons why I choose not to participate in this model of payment for my services. I invite you to comment and share experiences you may have had related to the points I make.

#1 - Cost Transparency

My fee is my fee is my fee. It’s the same for everyone, regardless of what insurance coverage you can or cannot afford. I set my fees at a rate which is comparable to what most insurance plans would negotiate to, meaning what you pay me as an out of network provider is likely the same (or maybe even less) than in-network providers. I have a flat fee, meaning, I do not charge for multiple service types on any visit. All services provided to an individual are included in the flat fee.

#2 - Clinical Congruence

Some insurance plans cover just a few visits a year, and some have unlimited benefit. While we’d all like to think our providers give us their best recommendations based on what we truly need, we’ve seen studies which show that the type of insurance coverage a person has will often influence their provider’s care recommendations. Or, a doctor’s financial ties to pharmaceutical companies or procedural innovation can influence a specific prescription or procedure. I believe in clinically beneficial care for all of my patients. In this model, everyone has the same access to this care without any externally imposed limitations.

#3 - Universal Access

Everyone has a spine. Everyone should have the ability to have their spine checked and adjusted when necessary. We don’t miraculously grow a spine at age 5, or 8, or 12. The idea that children specifically can be excluded from some insurance plans is MADDENING to me. By having a flat fee system, I don’t have to charge more for the 1-year-old who is excluded from chiropractic benefit that the rest of the family receives. My fee is my fee is my fee.

#4 - Health Care vs. Sick Care

Many insurance plans are structured the way that they are (limited visits, high deductibles, benefit exclusions) because insurance is not, in reality, focused on “healthcare” at all. Insurance covers emergencies and doctors visits for acute and chronic illnesses, and often covers what they consider “prevention” services like mammograms, colonoscopies, annual physicals. I challenge you to consider that these services are really not “prevention” at all, rather early detection. A mammogram cannot prevent breast cancer. What prevents breast cancer? The best a person can do to prevent it is to live a healthy lifestyle. Clean eating. Move well and move often. Stress management… THESE are preventative activities. Does insurance pay for our groceries? Our gym membership or yoga classes? Do we get reimbursed for taking time away from work to meditate or pray? Certainly not.

Insurance companies who do cover chiropractic services generally do so under a model of sick care. To them, chiropractic is about neck pain or back pain, maybe headaches. In reality chiropractic fits in the prevention model under the “Move well and move regularly” category of living a healthy lifestyle. All of the components of a healthy lifestyle are things we each have to make a personal commitment to, and each has a cost of time or money which actually add to the VALUE of those practices. People tend to cherish the things they work hardest for… I will do my part to care for my practice members, and challenge them and you to adopt little habits every day which will add up to making this year a pivotal year in your health and wellness.