Why do I need to pay if I have insurance?
The Health Insurance industry in the United States is seriously flawed. Premiums are sky-high and deductibles are ridiculous. Still, if you are paying for insurance, you expect to be able to go to any doctor you choose and have your services covered. Most people expect to have a copay of $10-20 and that is all. Another thing many do not understand is the difference between In- Network and Out-of-Network doctors. Insurance companies want you to see In-Network doctors because they usually have contracted rates with the companies. This means the doctor legally can not set their own prices (remember that next time you get hit with a bill after seeing a doctor). Most chiropractors in NYC are Out-of-Network, which means they can set their own prices and if an insurance company only pays a portion of that, then legally, the patient owes the remainder. This too can get confusing for the patient.
Still, the most confusing thing for most people seems to be the concept of deductibles. If you are seeing a chiropractor that bills your insurance $300/visit and the insurance company only pays $150 of that charge, then theoretically you owe the doctor the remainder of that, which is $150/visit. Most offices whose billing is like this will usually write off the patients balance for hardship or other reasons. Here’s where it gets confusing (I don’t enjoy this math).
If you have a $1,000 deductible and your insurance is paying $150/visit, then it will take 7 visits before the doctor receives any money at all from the insurance company. Deductibles in the $100’s of dollars were the norm 10 years ago and earlier, but now, thanks to Obamacare, most individual deductibles seem to be around $5,000. In that scenario, it would take 33 visits with the insurance company paying $150/visit before the doctor gets anything. Most insurance companies will also not allow patients to see a doctor 33 visits or more and so that becomes even more of a problem.
So, you can probably see why more and more doctors are turning to cash only practices. Instead of charging $300 or even $150 for a visit, they are offering more manageable fees so that people can save on their out-of-pocket expenses. It’s still difficult for most people to see that by offering a visit at $75 cash is saving the person from having to pay the $150 or more per visit. Utilizing insurance also incurs the fees associated with the extra time to fill out paperwork, process claims and in many offices, the usage of an outside billing company to process such claims.
Most chiropractors are trying to offer their services at the lowest possible rates to make it easy for the patient. Most patients don’t really understand the value of chiropractic past their aches and pains. When you realize that the real point of chiropractic is to enable your brain and body to work together and allow your body to function and heal despite what life throws at you, then that $75 will seem like the greatest bargain in the world.