Insurance today is a tricky thing. We are seeing more people confused than ever. In Network, Out of Network, which is important? Which covers?

The truth is that 90% of insurances we are seeing pay us $0 a visit. That being said, we look up as many as we can, trying to reduce costs for patients. The most common misconception I see is patients thinking they have to see an in-network doctor. This is simply not true and the days of services covering better in-network are gone.

My pet peeve; the word “covered”. It’s the word insurances companies tell you when you call or when you sign up, convincing you that you are in fact covered with no cost on your end. In reality, almost every insurance company allows 20-30 chiropractic visits, but covered usually means a meager 0-10 dollars payment to the chiropractor. The insurance company considers you “covered” when you have 25 visits that pay the doctor $0 each visit. Do you really have 25 visits covered when the payment is $0? Obviously the answer is no and no business can survive on $0-10 payments.

In network insurances are typically a $20-$40 copay which mostly eliminates any payment we can get due to the subtraction of your copay off any pending payment amount. Out of network usually consists of a larger deductible that must be met before any payments are made and doesn’t involve copays. It’s possible to have either pay but in network or out of network is no better than each other. In fact, lately both are usually unreachable and unusable.

Insurance companies are raising copays and deductibles while simultaneously lowering the coverage amounts. We have to make a profit on each visit or we simply won’t be in business.

My concern is an increasing number of upset patients who were expecting visits to be covered in full and are not. We would love for all insurances to cover in full, but those days are gone except for a small minority of plans. If your insurance covers more than $25 a visit, you are doing well. We would be happy to look up both in and out of network and explain your coverage.

We do our best to bill insurances despite declining payments each year. Rising copays and deductibles, increasing medical reviews, lack of policy info online, outsourced insurance call centers, processing errors and fine print are at an all time high. I see doctors offices quickly being forced away from insurance and into a self-pay/membership model as the only method to survive. We keep our prices reasonable to stay competitive and allow your continued support of our business. Thank you for supporting myself and my family over these last five and a half years.