Out of Network Trumps In-network providers

How health insurance has control over your in-network provider.

It is more common than not that insurance companies control your healthcare providers by deciding what treatments a patient may get at a in-network clinic based on what they will pay for. It would be nice to think they would pay for any/all treatments that might really help your specific condition or injury, but as usual it’s all about the money and finding ways to tweak the system. First it’s important to understand that healthcare insurance makes the rules about, what is covered, how much they will pay, and make constant changes to the “rules”.  We have decided that it would be better for us and our patients at Grace Chiropractic Center to avoid this as much as possible.

Our office is out of network b/c  most in-network clinics normally don’t provide the highest level of care. Reimbursement to providers is regularly lowered causing them to have to see many more patients to make up for the lost. This causes clinics to use more treatments that are better reimbursed by insurance companies, which may or maynot be the actual treatment you need.  They also tend to use more assistants/associates to provide the treatments. It’s common to see more unattended treatments such as: being hooked up to therapy machines, or do these exercises and I’ll be back, or we are going  to do these treatments as a “group”, and we need to see you as much as your insurance will pay for it.  We believe that for the most part patients are smart enough to do many exercises at home, when properly instructed and educated. Also popular “new” treatments are “set it and forget it” meaning hook them up to something and leave them while you go hook someone else up to something.

The phase ” We will verify your insurance for you”. Meaning we will see how many times your insurance will let you be treated, even though you may not need  8 weeks of treatment. I don’t feel like a patient should be billed for hours of exercises in a office that could be done at home once the patient has learned them. Another common situation is, the patient isn’t improving after 8 weeks of care, so they do 8 more weeks of care.  I have had patients in my office tell me that they have been treated for 8 weeks and were not responding so they did 8 more weeks of treatments and still no better, so they did 8 more weeks of treatments and finally just stopped going.

It’s been my experience that “in-network” offices always see patients 2 or 3 times longer than cash based offices/time of service offices. Our business model  tends to see patients for shorter treatment plans, provide quicker results and happier patients. The highest level of care and beneficial treatments are not the priority with typical in-network clinics because they need to do the treatments that pay the highest and see the most patients per hour.

Our office never asks the patient how many visits your insurance pays for, what is covered or let us verify your insurance. Our goal is not to become the biggest office, but to be the best we can be. Our patients are our greatest asset. For many patients our office fee is less than what they would pay at a in-network office after the deductible is met and then the co-pay for more than needed treatments is paid. We treat our patients one on one and reduce treatments as improvements and goals are met. Some difficult cases take longer than others and that’s to be expected especially with auto injuries. You can see our videos and read more about us on our website. We hope to see you soon.


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