Hi Joel, I wanted to write and say how much I enjoy all of your postings and messages. They are always a great inspiration to me. I was wondering if you had any wisdom & suggestions concerning establishing an appropriate fee in this day / age what with managed care, etc. In my area third party pay indemnity insurance is a dinosaur. Everybody either has an HMO / MCO or nothing at all. I am finding it very difficult to maintain an adequate case load and also have a reasonable fee that most people can (will?) pay. I find it is more like "let's make a deal" and too often I am not making enough to make it worth it. Don't get me wrong - I love what I do and I very much enjoy the care giving end of it but I need to make a living at this or I might just as well go into something else. Just three years ago I could expect to see 45 -55 people per day and take in approximately $1500 per day. Now a good day is 40 per day and we only take in $300- $600. The over head, nevertheless, remains what it was two years ago or higher. (the cost of living is always increasing) I have many people coming in for only the co-payments (10 -$15 ) because the MCO only pays $1.54 per visit ( so it doesn't pay to even belong and do all of the paper work. I have dropped out of most of the MCO's and HMO's but as the phone rings and people want to know if I belong to their plan - I say sure - come on in and I never tell them I don't belong because they will just go to the next guy who does. I want to establish a reasonable fee that the average person can afford / and not quit care - regardless of whether or not I'm in their plan and one that is still reasonable for me also. What do you recommend ? How are others getting around this MCO business? At present , it isn't worth going to work as it costs me more to run this show than I'm taking in. I recall years ago, I knew of a chiropractor who charged $6.00 per OV and $8 for the entire family. That was before licensing and all of the insurance and overhead problems started. He was raking it in and having a ball doing it. Now, if you charged a low fee like that, we are told that we are devaluing what we do. Yet if we charge $20 or $30 - nobody is going to come in - at least not for 3 times then two times then one time per week like we need them to do to get them better. I am very confused - should I say come in one time per week and pay me my usual fee of $30 per visit and ...hope for the best or be honest : tell them they need to come in 3, 2, then 1 time per week and watch them walk out the door? I look forward to hearing from you and what you have to say about this Regards, A: Thanks for the e-mail. This is a universal problem and is placing many DC¼s in a position they rather not be in. Unfortunately .. this seems to be the trend for the near future. The only salvation of all this is to get your mind away from the insurance mentality and into the Big Picture On Purpose mentality. You have to reorient your thinking that there is no insurance but people that need your care. I also have these problems and as we both know .. even with insurance the number of visits may be limited anyway. I recommend you begin gathering your thoughts about extended or „corrective¾ care. No matter how a new patient comes in .. let them know your intention is to allow them to make the decision about which care they want .. relief or patch up or corrective. Let them further know that their insurance policy may only offer them relief care .. and since you practice within their parameters (which are for acute care only) you will be releasing them from relief care after 8- 10 visits .. but them may wish to correct or further stabilize their condition. Does this make sense? (ask them this). Okay .. after a few visits I will outline the care I would recommend and the fees it will cost beyond the insurance .. is that fair? (ask them this). Most say yes! Within a visit or two outline their problems showing x-rays structural instability .. soft tissue irritation .. present symptoms and history of spinal insult .. and then outline a schedule of 30-40 visits over a period of 6-8 months. You do not have to lower your $30 office visit fee. If you use the outline I wrote and use today .. I breakdown their insurance visits to 10 or 12 and then I outline the rest of the visits. I give them a period of 32 weeks to pay it off .. in other words I am still getting all the fees I request .. just spreading it out over a 6 months. Think about it .. a person is paying $10 a visit as part of their co-payment (by the way .. whether they are in your HMO or not) .. that is usually $30 a week .. once their insurance runs out (some will protest that their insurance allows 60 visits per year .. right .. these folks must be terminated from your program or told with no uncertain terms that their insurance allows care for acute conditions only and at this point their condition is chronic or in the realm of maintenance or supportive care .. they can also call their insurance .. they¼ll back you up) what you wish to do is go beyond the wording of the insurance company and offer further spinal stability if they wish (be sure you outline their need and place a value to it) To help them ..you outlined .. here on paper .. the number of visits you recommend and the fees they will be responsible for .. and you spread it out over 32 weeks. Then discuss it further and let them agree or not. If they say no .. then request they return in one month for their co-payment fee to see how they are doing and they can decide if they wish to correct their spinal condition then. Then whether they agree or not ..attempt monthly regular fee maintenance care. Below is the form I use .. get their credit card on account as you will be billing even though they are not coming in as regularly. I hope this helps Have a Great Day Dr. M Relief or Corrective Care Patient¼s Name ___________________________________________ Date ___________________ In order to assist you with the care necessary to provide relief as well as attempt to correct your spinal condition the following will help in your decision. If money and time is a factor we recommend you choose the relief schedule, but if you wish to benefit from the potential of chiropractic care and be pro-active in preventive health care then corrective care would be your best choice. The choice of care is yours. First the difference between relief and corrective care. __Relief Care: As long as it takes to provide pain or symptom relief. Time necessary depends on many factors .. structural instability .. history of injuries or repetitive joint aggravation .. patient¼s age .. family history .. recent factors that brought you to our office. On average .. a schedule of between 4-8 visits over a period of 3-4 weeks may achieve the results as well as begin to stabilize the area(s) of concern. __Corrective Care: A process of further stabilization and rehabilitation of the specific area(s) as well as maintaining the supporting structural regions. On average this care extends beyond your relief schedule over a period of 6 months with less care rendered after the initial relief schedule ends. Correction is dependent on many factors including age, weight, level of exercise, nutritional balance, lifestyle habits, work routine, sport activity, accident history, structural weakness and instability and more. Therefore, the word correction would best be served as management. On average .. a corrective care schedule is between 30-40 visits within six-twelve months. Your insurance carrier provides for Relief or Acute Care only. This is for a short time frame. Chronic conditions warrant further care and will be your responsibility. We estimate your carrier to cover only _________ visits for the acute period of care Your corrective care schedule with an estimate of fees and times is as follows: Ä Relief Schedule: _______ visits over a period of _____ weeks Ä Corrective Schedule: _______ visits total over a period of _________ months Ä Total of visits between relief and corrective schedule is: ________ Corrective Care Fee Balance without therapy @ $35 $ ____________ Corrective Care Fee Balance with therapy @ $60 $ ____________ PCD* Corrective Care Fee Balance without therapy @ $25 $ ____________ PCD* Corrective Care Fee Balance with therapy @ $35 $ ____________ PCD savings of with therapy $ ________________ without therapy $ ________ The most important facet of care is repetition and momentum. Whatever schedule you choose it is imperative that you follow this schedule. Therefore, your decision concerning corrective care and our schedule of specific dates and programs should be decided shortly. Payment Schedule Payment Options over a period of eight (32 weeks) months (Paid the beginning of each week or month) Weekly payments with therapy of $ _________ Weekly payments without therapy of $ _________ You can also save 10% of the balance by making one payment for the above schedule. During the accepted period of treatment you are responsible for your co-payments only. Requested care beyond this period will be your responsibility with a credit card imprint on file. We can either bill your credit card weekly or monthly. If you have no credit card your personal check will suffice. We rather not bill you for these visits. Often payments will be for services already rendered. Please be current on your account. If we need to bill you and a collection service is necessary all collection fees and interest will be your responsibility Name on Credit Card: _____________________________________________________________ Type: ____MC _____Visa ____AMX Credit Card # ____________________________________________________ exp: _____________ * Preferred Chiropractic Doctor program costs $35 a year per individual to join. Our normal fees are $35 an adjustment and $15 for therapy. PCD allows you a substantial savings at $25 per adjustment and $10 per therapy. I have read the above and agree to the provisions outlined. I understand there is no guarantee of health care results. If for any reason, I wish to discontinue care and have pre- paid for services, I will be reimbursed for all services not provided at the rate the appropriate fees above. Necessary care beyond the above schedule will be discussed and similar financial arrangements can be made Signed: ___________________________________________ Date: ________________ Witness: ___________________________________________ Date: _______________