Q:

I cannot compete with managed care and can not get in. Ižm ready to quit.

A:

Thanks for your reply. I've been in practice for 22 years. When I graduated in 1978 there 
was little to no insurance for chiropractic care (except there wasn't the competition from 
HMO DC's to contend with). The balancing issue today is the understanding and value for 
chiropractic. Years past we were looked on as charlatans (some still think this way) and it 
was a hard sell to have patients understand the value and big picture. Today we have a 
greater exposure and therefore people from every walk of life sees us as an asset for their 
specific problems .. regardless of insurance coverage .. not all wish to participate but they 
see we have some use. 

Okay .. it is true people follow the insurance benefits but as you also know these policies 
are very limited in terms of total visits and what can be done .. therefore the problem for us 
is not trying to get into an HMO (by the way .. I helped create the Cigna and Aetna DC 
panel in Atlanta) but getting into the heads of the patients. If you ask the DC's participating 
in local HMO's you'll find that they may be able to see a person for a limited time and ask 
for a small co-payment during this time .. afterwhich they must "sell" the story and see the 
patients on their own dime for what is needed beyond the parameters of the HMO. So .. 
where does this leave you .. it leaves you at the same door of the HMO provider except you 
have to educate them before laying your hands on them. 

Example .. here in Atlanta. If you call me and ask my CA what Blue Cross pays for a 
chiropractic patient and she'll tell you they allow only 10 visits per condition and their co-
payments are usually $10 per visit. BC will pay a $35 visit with $ 20 .. so if you add it all 
up .. the patient pays out of pocket for these 10 visits $100 and the insurance covers $200 
for a total f $300. This is it. Now if you wish a successful practice and pay bills you cannot 
live on this unless you have huge numbers of patient visits per week or you can begin the 
process of educating your patients to the value of prevention and correction and stablization 
and suport or whatever terms you feel appropriate for increased visits. Listen .. how many 
adjustments have you had since being a chiropractic patient and then student .. was it more 
than 10? So .. whether you discuss the subluxation process or biomechanics .. structural 
stabilzation or sports enhancement .. ergonomics and safety to whatever .. once you 
understand your purpose towards community Wellness .. you'll have your desire to get 
that message across to others and therefore reach way beyond the ten visits that are offered 
to the Blue Cross or other HMO patient.

If I were you I would begin calling some DC's who are actively within these HMO's and 
find out the parameters. After you know this create a handout describing your policy for 
HMO patients .. something like this: (by the way .. I am writing this quickly and out of my 
head so clean it up and see what you feel comfortable saying with possibly less words)

This office has an active policy to care for our community regardless of the limits allowed 
by many of the managed care programs. Below is an estimate of some local HMO/PPO 
programs as gathered from local in-network chiropractic providers. We have decided to 
match the co-payments plus $5 during the restricted policy limits with your understanding 
that further care will be at our usual and customary office fees. Unfortunately, each 
individual's structural problem is unique and may require care beyond the restricted limits 
of the insurance coverage. Furthermore, many patients request the ability to further stabilize 
and correct their spinal problem as a means of being Proactive towards Wellness. We wish 
to participate in our patient's and community wellness and therefore offer this program to 
you and will discuss a corrective and/or supportive schedule to you once we determine 
your specific structural needs.

Below are the general and estimated parameters of some of the local managed care 
programs. Please note that this may not apply to your policy .. to be sure call the number 
on your card for their guidance. (mn = medical necessity .. determined by the doctor's 
follow up reports and usually is indicative of restricted visits beyond the initial series .. 
PCP = primary care physician .. your family doctor)

Blue Cross .. 10 visits per condition .. $10 co-payment  .. mn
Cigna .. 15 visits per condition after a referral from your PCP .. $15 co-payment

Office Policy:

We will match the number of visits as outlined above with an additional $5 per co-payment 
during this restricted time. Once we determine your chiropractic needs we will discuss my 
findings and offer you the choice to further stabilize and correct your spinal condition. As 
noted above,  you may wish to be proactive towards wellness and health and take 
advantage of this. We ask that you decide with knowledge and understanding and any 
questions you may have should be answered before you decide. Chiropractic care is a 
physical method of health care and requires repetition and momentum, therefore a schedule 
will be outlined to you and should be followed to achieve the best results.

I would give this letter to every person you meet that has insurance and decides to go 
elsewhere. I would get back on the lecture and screening circuit or use this wherever you 
plan to reopen and go for the gold. Yes .. you are seeing patients for an extremely reduced 
fee .. at least initially .. but this will even out if they decide to see you over a longer period 
and pay your office fee. The key is to map out a financial fee program . look within my 
webpage under Practice Tips and scroll down to my stuff and look for a "financial 
worksheet" or within my Smart Start Book Chapter Two use one of them there.

I understand that many schools within chiropractic thought differ dramatically. Those that 
feel we help aches and pains feel care beyond this is unprofessional and others feel that 
lifetime care is necessary. I have no further to look than myself and my family of 5 to see 
the value of lifetime care .. the choice is yours and once you have the understanding of the 
Bigger Picture . you have the desire to tell the story.

Give this some thought .. just for the hell of it .. use the survey mentioned in my e-mail 
(again found in my webpage under Practice Tips .. the third or fourth entry) and survey all 
your patients .. try hard to give a number of workshops for one or multitudes of patients 
and give them a handout to give to their fellow employees .. forget the HMO's and see 
beyond it.

This is a critical problem for more DC's than we'd like to discuss .. but if you go with the 
flow you'll be swept under .. keeping your head above and treading water is just getting by 
.. but stroking hard and fast with the current will get you into the game. Find a picture of 
salmon flying upstream as a mantra for yourself .. motivating you to get to where you want 
to go. Just be aware the end result of the salmon's journey is death .. so once there .. 
change streams and prosper.

Have a Great Day

Dr. M

By the way .. keep in touch