Q: Hi Doc, I just ordered your floppy disc and your book, "Chiro. Marketing & Public Relations" and I had a question about the Communtiy Health Network. I am just starting a practice and I am not in any of the HMO's. So I thought that this was a great idea when I read it but I don't understand why people who have an HMO and pay no deductible and maybe a 8-10 dollar co-pay would want to come to me. How do you go about making any money from these cases??? Because I can't match what they could get if they stay within their HMO....I can't bill their insurance because I'm not in the HMO...so I guess I have to charge them cash but at a 20-30% discount??? Please help me to understand what you are saying here because everyone wants to use their HMO around here and I want to be able to help these people even though I'm not in their HMO. I would like to know what to say to these people and how to make any money from their cases?? Thanks a lot Doc for your help!! A: Thanks for your e-mail. The Community Health Network was an easy way for your to meet your community and have something to provide them. The only way you will build a new practice or even sustain a veteran clinic is to continue to promote it. If you are unable to get within an HMO .. you need to get in the ball field at least. If you come up with a unique program to offer Mom and Pop shops and other institutions in your community .. many with limited to no chiropractic coverage you are at least in the game. If the company has benefits .. then you may not have the effectiveness to offer a reduced fee for services unless you want to reduce their co- payments 50% or so .. but you at least have the ability to offer workshops and other programs and continue to send them via fax .. regular or e-mail special newsletters about Wellness and Ergonomics. Also .. you may be able to utilize their out of network insurance benefits. Call the insurance company and ask if the patient has out of network benefits. If they do .. they may pay you after a higher deductible and co-payment is paid by the patient .. at times this is even better benefits than if you were in network. If this is possible .. work with these higher deductibles and co-payments. Remember .. if you call a local DC within these networks and ask them what coverage an in-network patient would have you'll be surprised at the limited visit number or actual payments from the insurance company. If you discuss the chiropractic story to the patient and give them the options between relief and comprehensive care .. and they choose comprehensive or more care you can work up a financial plan that provides all the care the patient needs with a comprehensive fee to take into account the non payment out of network benefits (at least take their co-payment and maybe $5 or $10 more) as well as your regular fees beyond the parameters of the insurance program. " Mrs. Smith, our office accepts all insurance programs. Unfortunately, your insurance program offers you limited insurance benefits. We understand that your policy allows a maximum of 10 visits over a 45 day period with your copayment of $10 per visit. We are not involved with your insurance company, but we their parameters with an additional $8 per co-payment up till the ten visits your insurance allows. During this time you will determine if what we are doing is helping and I will have the opportunity to understand your problem and discuss what I would recommend to correct it. Care beyond your insurance program will be at out usual office fees, but I will work up a program for you including schedule and fees. Does this make sense?" Work with this. Have a Great Day Dr. M