Insurance is constantly changing with Obamacare and it appears this is going to be no different under the Trump administration. Things used to be simple; it wasn't too long ago that a co-pay meant a co-pay. Now things are not always as they appear. As a result, many chiropractic clinics and other health professionals are leaving insurance plans and companies altogether, or sticking only with the larger groups such as: United Healthcare, Aetna, and Blue Cross Blue Shield.
There are many pros and cons to both the consumer and the provider regarding chiropractic care and insurance plans. There is not an end-all-be-all answer that will suit everyone's needs. The main advantage of utilizing insurance is to benefit the consumer, as it should be. You know when paying for a service, the money is going toward your deductible and paying your monthly premium is not a lost cause or only for catastrophe type situations.
Deductibles are rising, there is no way around this. This is the largest con for deductible/coinsurance type plans. You, as the consumer, have to pay a larger amount, for a longer duration, or normally both. We are also starting to see coinsurance plans for certain services being applied on top of co-payment plans. This is frustrating for all parties involved.
I know as a practitioner that certain situations/conditions may require a couple more visits once pain subsides to fully address an issue. However, with the rise in deductible prices, many individuals are not always willing to pay once pain subsides. We, as a society, are trained that once pain is gone the problem has been corrected. This increases the prevalence for relapse, once again causing pain requiring more money, time, treatment, and frustration for all parties involved.
Once the deductible amount has been reached, cost for services usually decreases to 10-20% of the original cost due to the co-insurance kicking in. This is great, however, it only occurs once the deductible has been met and many times the limit on the number of visits per year for chiropractic care has already been met. This can make some individuals wait till the end of the year to seek help, increasing the duration they experience pain turning a simple fix into a complicated situation, requiring chronic care or treatment plan (more visits potentially required).
Co-pays are not always co-pays. We are starting to witness some insurance plans only covering the initial exam and adjustments under the co-pay. Everything else goes toward the deductible and must be paid in full as in a usual deductible plan. This means in order to treat multiple sources and types of pain (i.e. muscles, fascia, tendons, ligaments, neurocommunication, nutritional, emotional, neurogenic, etc.) a more comprehensive treatment approach will cost more than the listed co-pay price seen on many insurance card. As the consumer, you feel you are being lied to by the insurance company or the provider. Trust me, as a provider, we are much happier providing all services at the co-payment price, not just some of the services.
In my opinion, co-payment plans still have the greatest advantage for the consumer. If it is a short treatment plan (<6 visits), then the price becomes more affordable, even with the additional deductible for the "other" services provided.
It is important for the consumer to understand that different insurance plans have different pros and cons. Insurance companies, including Medicare and BCBS, are very adamant on what direction they are planning to go with reimbursement for all health professions. Currently, insurance pays for a time-of-service approach. As long as there is medical necessity, insurance will pay for care. Recently, insurance companies are educating all health professions that they will be switching to an outcome-based repayment plan. This will drastically change all health professions, not only chiropractic. The future is unknown and the pros and cons of utilizing your insurance for chiropractic care is changing as well. Hopefully for the better.
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