Q: Hi doc, I have been LIVING on your weekly emails...and I want to say thank you very much. They provide me with inspiration! I have a question...and I apologize if it is too long. I am about to start practice and I have recently come across a method of signing people up for care plans...and I am wondering about the legality of it.. your input would be greatly appreciated. The method works like this: I have a patient agree to a care plan of 50 visits or so. I calcualte the entire length of the care plan and what it will cost (say $2000) and call this my 'retail fee'. Then I tell the patient that this is obviously more than most people can afford so i have a cap fee in my office for this care plan. lets say 1400. I tell the patient that I have called into their ins company and they have comfirmed they will cover a certain ammount of this plan (say $700) and that the patient is responsible for the remaining $700. they can pay this installments, or they can pay it all up front. my question is this....beacuse the patient is not paying the full retail fee($2000)....but rather only responsible for the remainder ($700) of what the ins. company wont cover on my 'cap fee'(1400)....is this legal? Even if the money paid in advance is held in escrow and withdrawn on a 'service rendered basis' A: Thanks for the e-mail. Donžt make collecting money so complicated. As a student the issue of dual fees and insurance versus cash fees is a big deal .. and it should be. As a student the teacher should teach only responsible practice procedures .. unfortunately .. it often isnžt practical. Success comes from diversity and the ability to adapt. Cash plans and creative financing is usual and customary within our profession .. especially if you are kept out of the insurance networks. Remember .. this is your business and as a business you can set your own fees and practice parameters within the scope of practice laws. I never recommend giving care away or discounting your fees drastically .. just be more creative with payment plans and as you were writing some discounts if paid in advance or over time. To avoid some pitfalls of dual fees .. you can join an organization called PCD .. Preferred Chiropractic Doctor .. this can be looked upon as a supplemental insurance program for your patients. It costs you nothing to join but $30 for an individual patient for a year. PCD allows you to legitimately by reducing your fees 20 or 30%. If interested call them at 1- 800-239-3552. Also there are many UCFAF plans or Unlimited Care for a Fixed Fee .. sort of what you are doing. Dr. Nikitow has a seminar concerning cash practices and Dr. Bob Hoffman the President of the ICA has a program he sells concerning UCAFF with forms and all. So .. itžs not an unheard of concept. If you are in Florida or a state that requires escrow accounts than you must abide by these rules .. if not .. like here in Georgia .. there is no need for such an account. Be sure to note on any contract or paper they sign that you do not guarantee any health results (they may feel that this period of care should resolve their problems permanently) and that you mention a prorated refund fee .. such as each visit being $35 and if they pay in advance and leave town or wish to stop care you reduce $35 times how many visits they came to that point and refund the rest .. obviously use the number you have. I have on my webpage under Practice Tips the Financial Worksheet I use sometimes which allows them to pay over a period of six months .. I attempt to get their credit card number on account first. If you make the weekly or monthly payments acceptable they will take advantage of it. My Smart Start Book has some forms as well. By the way .. if you find value in my weekly e-mails and you know of other DC's with an e-mail address .. please have them contact me about my weekly e-mails or send me your chiropractic e-mail address list and I'll get these folks on board. This is how my list grows While I have your attention .. a mild commercial for my books: If you wish to purchase my Smart Start Book ($60) or my PI Workbook ($25) or Workshop Workbook ($25) or the PR and Marketing Book ($25) or a document disk for the Smart Start Book with the forms and letters and a complete narrative with ratings for Windows and Mac (please request which) ($15) .. you can do it on-line at http://www.chirostore.com/catalog/cat8.htm .. or call my office at 770-491-3639 and order it directly. Webpages: Also .. if you wish to explore having an office webpage with timely updated specific interest articles informing your patients and community professional alliances .. check the following prototype office webpage. We can create a similar or webpage of your choice. This innovative program has components including my timely marketing ideas. If interested e-mail me at joel3639@aol.com further information. Please check this webpage: http://www.mindspring.com/~joel3639 Have a Great Day Dr. M http://www.mindspring.com/~chirosmart