Here's my idea for dealing with insurance hassles. Fire the bastards. Sell the idea of chiropracTIC. Its not about diagnosis and treatment of anything. It is about the expression of II thru IM. Surprise, surprise, practice members can and do understand this and will and do pay cash money to receive this unique service. Unique to our world is LACVS in anyone with a spine, not just medically needy cases. I stopped being an insurance whore four years ago when it finally got through my uppermost osseous density that it was a lie to say that the patient's(ptew, bad word) condition started any time later than birth and would resolve anytime before death. Also that my educated brain could accurately prognosticate the exact moment the condition would resolve. If one seeks financial freedom from third party payors, dig into the roots of the profession whose name graces your hard-earned diploma. Search your soul for the motivation of your decision to become a chiropractor. Was it to be part of the modern health care team or was it to liberate the expression of spirit in flesh? Both chiropractic and medicine are necessary but they are different in philosophical constructs. Get the big idea and all else follows. Our job as chiropracTORs in solely in the arena of subluxation. Clear the clutter of divergent purposes and get to work living up to the principles of the profession you signed up for. If your school didn't teach them, get busy correcting the cause of your present money worries, learn the philosophy, discover your purpose and share the truth. Geez, I'm fired up. Gotta serve my people! ChiRhodes@aol.com Dr. Margolies, My area is heavily insured by HMO's. I've been very active at screenings since starting my practice a year ago. I've experienced MUCH frustration with excited prospects cancelling. After several months, I realized that it was PROBABLY due to the prospect going home and identifying that I'm not a provider on their network. So two things I do now: at the screening, I deal with the objection before it comes up--I say, to not be concerned if they find that I'm not on their network because I have a way for them to utilize their benefits in my office. This is how I let them utilize their benefits: I contact their HMO and find out what their coverage is: 1)"copay" and 2) number of allowable adjustments. Say they get 20 adjustments for a $15 copay. I advocate 1 year of care plans, I calculate the care plan (typically 80 adjustments plus re-exams, re-x-rays, etc.) and I show them what it costs for my regular fee per adjustment and then the cost with a capped fee and prepay discount. So when I calculate the cost of their year of care, I recalculate the first 20 adjustments at $15 and the rest at my regular price. You can really upsell this by pointing out that these first 20 adjustments are GUARANTEED to only cost them $15 AND they don't need a referral from their MD (because you're eating the difference--you're not really billing their HMO). You don't necessarily have to point that out, sometimes I do, sometimes I don't. As most of us know, even if their plan COVERS 20 adjustments, 20 adjustments are not guaranteed to be paid for and there may be a surprise balance at the end of care. I don't participate in any HMO's and this has been a decent solution to keeping patients who think they have chiropractic coverage, when in fact, they barely have relief care for their chiropractic benefits. If you're not selling extended plans (like 1 year), try 3 or 5 months. If you try this with someone who is only paying for 1 month at a time, or even worse, per adjustment, it's vital to establish up front how many adjustments will be at the discounted rate and that subsequent adjustments will be your regular fee. I think that this suggestion trickled down from Tony Palermo, but I'm not sure of the source. It has to be tweaked on a case-by-case basis. But it's something that can be done to keep people from walking out the door! Much luck, Yours in health, Erica Kasprzyk, D.C. (seligman@mindspring.com) Before we went all cash (except Medicaid who can't get reimbursed) on January 1, 2000, we accepted insurance for the first six months of operation. I used the following method to reverse denials: I wrote a letter from the patient to the HMO stating they had been informed by us that their HMO had denied us entrance and that since they required a female doctor, provide her with the name of an acceptable female chiropractor in our county (we're the only one). I forwarded the letter to the patient with a SASE to the HMO. Within days we received a personal telephone call welcoming us into their HMO. When we went all cash, we reduced our fee by the costs of claims processing and HMO payment reductions and edited our advertising to stress the "Improved Pricing Plan." This brought in more visits than we lost from people who didn't want to prepay and bill their insurance themselves. Bruce Clark (bccapital@excite.com) ChiroSpace.com Hey Doc Just wanted to give you some feedback on your hanging in there article. I have written you before, as I told you, you had taught me at Life and I really enjoyed your class, I still have your book that I like to look at periodically. I have had a practice in Birmingham AL. now for just over a year and am doing quite well I think. I consistently see 160-170 patient visits a week and am continually growing. I do accept insurace in my office but I have over 80% of my patients on some type of cash plan. About 1/3 of my collections each month is cash up front. I have roughly 10-12 Chiropractors within a 10 mile radius most of whom are seeing beteen 60-80 visits a week and all have been here for at least three more years than I. My success I believe is due to a practice management group that has helped me develop a solid office policy with consistent procedures that are reproduceable and very predicatable. Now I don't want to sound like a commercial but I feel I would be doing my fellow Chiropractors a disservice if I did not mention who helped me get to this point in my career so quickly. I am a member of Waiting List Practice with CJ Mertz. He has given me the cook book solution to running a successful practice in these times of Insurance disarray. Most of us students coming out of school believe that we know a lot more than we actually do and this tends to hamper our success. I have played sports all my life and the best teams I had played on had a great coach. This is one of the reasons I picked CJ, he is a great coach and helps us with the fundementals of running a practice. The reason I felt so compelled to write to you is that I think Managed Care sucks just like everyone else but as I have found in my practice if you educate your patients about Subluxation and the adverse affects it has on our day to day life. It really doesn't matter what insurance is going to cover the patients begin to understand that they have to take control of their health and they are willing to pay for it. Now granted to some this may sound like a great sales pitch, especially to those who have run a pain based practice but I know we all see the same types of things in our offices everyday. We see children under 5 years old with tubes in their ears and a past prescription lists longer than our arms. Elderly patients taking enough drugs to kill a small cow and everyone else on Prozac or Claritin or both. I think telling the truth about how reactive based our society is today is not a sales pitch but a truism that must be told. Well I hope this is the type of feedback you were looking for, I just thought I would give you another opinion and to help reenforce what you were saying, Hang in there. If you tell the truth, speak from your heart and practice with passion you will succeed and you will help people live a happier and healthier life. Chiropractically yours Dr. Dean McIntyre (bamadoc9@mindspring.com)