THE SPINAL COLUMN

 

June 2013

 

How Big is Your Ripple?
One summer when I was a teen I spent every sunny day at the local swimming pool with my mother and brothers. Looking back on that summer I am amazed that we had so much fun, considering that much of it centered around some form of near drowning circumstance, like mercilessly splashing in the face or rapid prolonged dunkings, or leaps and jumps off the diving board that make me hurt just thinking about them.

There was one thing in particular that used to bother me then, and it is probably still true today. The adults didn't want to be splashed or dunked - or anything else that we kids were doing in our fun frenzy. They didn't seem to laugh out loud or smile like the kids did either. They would get annoyed whenever kids got too close to them. So we were "punished" by having that dreaded adult swim. This was a 15-minute period every hour where adults had the pool all to themselves. During those agonizingly long 15 minutes, the adults would basically wade around, holding their stomachs in, patting the surface of the water with their hands, the daring ones doing a few crawl strokes with their heads so high out of the water that their chins did not even get wet. So you knew as soon as the whistle blew signaling the end of adult swim, as if driven by some mad instinct all the kids would collectively jump in the pool from all edges and do our best to splash them all. The more water we moved, the better the effect.

"Making waves" and "rocking the boat" are things that happen only when you move the water. These expressions indicate that something is making a difference. When you drop a grain of sand in a pond the ripples are weak and barely extend a few feet, affecting very little near the edges. But use a big rock - kerploosh! -and the ripple will be strong as it spreads to even the farthest shore!

A few years back, I received an article from a chiropractor that had said that people do not need to understand chiropractic to get the benefits from regular care. This statements was among a list of other things that he wrote, so at first it didn't stick out too much. But when I re-read that statement, I realized that this was making a tiny ripple with tiny effects. If he had said that people do not have to completely understand chiropractic to get some of the benefits of getting checked regularly I would agree. It seems reasonable that the individual being checked regularly would benefit by living some part of the week free of vertebral subluxation (for however long, at least until the next one is caused). That's of immense benefit to that person to be sure, even if he had no concept of chiropractic.

But when it comes to the benefit of chiropractic, though, there's much more on the list than an individual life free of vertebral subluxation.

The person who understands why they are getting checked will also choose to have their family checked. They will also be open to the idea of telling their neighbors - hey who wants to live next to a subluxated family. What if the guy next door owns a viscious pitbull?  Do you want him building the fence that will keep that dog from getting into your yard and attacking your kids to be built while he is subluxated?

If they understand, they will also agree that the local police officers -- armed and having to respond to unusual situations -- should be checked. Add to that list of people in your community the teachers, the school bus drivers, and the other drivers on the road who are separated from this individual by a barrier consisting of a paint-stripe! How about the people who prepare food in their local restaurants, deliver explosive gasoline to the local stations, process their kids' college applications, clean up hazardous debris from the curbsides, count the money in their bank accounts, join the nations armed forces, etc.? Which one of these people should be left subluxated?

Doesn't this one individual benefit from all of them living free of subluxation as well?

And when it benefits his entire family, it also benefits the entire next generation - and the one after that and all those to come who will be on the distant shores of a future yet to unfold. All because that one person understood what it was all about. There's more to chiropractic that ignorant compliance.

There's a world to rock!

You have to make some waves!
 
Food Insurance

One question I sometimes get (usually at a public event) is, "Why don't you bill insurance in your practice?"

 

There are more and more doctors, both MD's and Chiropractors, who are leaving behind the ball and chain of medical insurance for different reasons, but the primary cause of this sea change in health care is the fact that it's hard for a doctor to truly do what's best for the patient when draconian insurance policies dictate the care that they'll pay for.

 

I was thinking about this idea when I saw this article.  I don't remember who wrote it, so I can't give proper credit, but it perfectly illustrates how medical insurance is NOT the answer for America's health care crisis.

Imagine going to your favorite restaurant.  You are greeted at the door by the hostess, who seats you and takes your drink order.  You order through your favorite waiter, Andrew, who recommends the special of the day: prime rib with a dinner salad and a chocolate torte for dessert. Soon after, the food is brought out and it is delicious!  You have time to enjoy your food.  You then receive the bill and pay for your meal, returning to your home satisfied, all your dining needs met.  Let’s say, for simplicity's sake, you paid $75 for this meal: $50 for the steak, $10 for the salad and $15 for the dessert.

 

A change then occurs in the restaurant industry.  A new form of eating out has been adopted.  Your favorite restaurant has now contracted with over 30 different ”restaurant insurance companies.”  

 

Anticipating another pleasant dining experience, your return to the restaurant with your new “subscribers card.” You pay your $5 “copay.” You sit in the foyer of the restaurant. You wait an hour, even though you made reservations.  A harried Andrew greets you and quickly takes your order after you briefly glance at the menu.  The food arrives at your table.  As you take your second bite, Andrew informs you that “your time is up” and the table is reserved for another party.  You are escorted outside with your hastily boxed left-overs.

 

What has happened to the restaurant?  Behind the scenes, the restaurant owner has learned some tough realities of the “new system.”  During the first month of taking insurance, the owner sends a form to the insurance company requesting payment for the $75 steak dinner: $50 for the steak, $10 for the salad and $15 for the torte.  The contract with the insurance company already states that they will only pay $45 for the $50 steak, but the owner decides that the extra customers brought to the restaurant by contracting with this insurance company will more than off-set this small loss.

 

The first attempt at collecting the $75 dollars for the full meal is returned unpaid with the note that it was rejected due to a “coding error.”  The forms for payment from the insurance company require the owner to list the parts of the meal, not by name, but by the numerical codes. The owner had listed the salad by the wrong numerical code.  No suggestions for the correct code are offered, so the restaurant owner purchases a series of books, at a cost of $500, to learn how to assign the correct code to the different parts of the meals.  These books will need to be bought annually due to the constant changing of the code numbers. After 30 minutes of study, the owner realizes the dinner salad should be coded as a 723.13, not the723.1 the owner originally put on the form.  The salad, it turns out, needed to have two digits after the decimal point, indicating that it was a dinner salad, and not a “main course” salad.  The owner mails the corrected form.

 

In response to the second request for payment, the insurance company does not send a check, but a detailed questionnaire:  Was garlic used in seasoning the steak?  Was it necessary to use garlic for this particular recipe?  Did the restaurant ask for permission to use garlic from the insurance company before serving the steak? Why was salt, a less expensive alternative, not used instead? The owner submits the answers, emphasizing that the garlic is part of a secret family recipe that made the restaurant famous.  

 

The owner waits another week (it has now been 3 weeks since the dinner was served).  The check arrives three and a half weeks after the meal was served.  The check is for $20 and states that it is specifically for the steak.  The check also comes with a letter stating that no billing of the patron may occur for the salad, but no other explanation is enclosed.  No mention is made of the $15 dessert.

 

The now frustrated restaurant owner calls the provider service number listed in the contract. After five separate phone calls to five different numbers (The harried voice behind phone call number four explains that the insurance company has merged with another insurance company and the phone numbers had all changed last week, sorry for the inconvenience…), the owner gets to ask why, when the contract says the steak will be paid at $45, has the check only been written for $20?  And what happened to the payment for the $10 salad and the $15 dessert?  

 

As it turns out, this particular patron’s insurance contract only pays $45 when the patron has reached their deductible, which this patron has not at this time.  The remaining portion of payment for the steak must now be billed by the restaurant to the patron directly.

 

The $10 for the salad would have been paid if the patron had ordered it on a different day, but, per page 35 in the contract, because it was billed on the same day as the steak, it is considered to be part of the payment for the steak and no extra money can be collected from the patron or the insurance company.  

The dessert, the owner learns, should have had a “modifier” number put with its particular billing code when billed with the steak and the salad.

 

Realizing that the insurance billing is quite a bit harder than anticipated, the restaurant owner hires a company, who is paid 5% of any money collected to specifically make sure these coding errors do not occur again and follow up on payment rejections.  For an additional $99 per month, the billing company will “scrub” the forms submitted for payment to make sure specific clerical errors will not cause future delays in payment.  

 

The owner now must lay off the hostess and the bus boy to pay the billing company, so these duties are now added to the waiter’s other responsibilities.

 

In the meantime, the restaurant owner has also had the waiter take on the job of answering the phones due to the now high volume of phone calls from patrons questioning why they are receiving bills for meals they ate over two months ago, and why did their insurance company not pay for this portion of the meal?  This extra work is now resulting in longer times patrons must wait to be seated, and grumblings from the waiters who “were not hired or trained to do this kind of work.”

 

The owner now realizes that, although the dinner originally cost $75 to make, only $25 has been paid. The remaining $30 billed to the patron is now in its third mailing, with the first two requests for payment going unanswered by the patron.  The restaurant owner realizes a collection agency must be employed in order to have any hope of receiving any portion of payment from the patron.

 

Each meal served now costs at least an additional $20 due to the added overhead of the billing company, coding books, and the collection agency.  These added expenses have nothing to do with cooking food or providing any direct service to the restaurant’s customers.

 

Service to the restaurant’s patrons has been compromised with these changes as well. The owner has now over-extended the waiter, who was an excellent waiter, but is now taking on the roles of host, phone answering and table bussing.

 

In order to even meet the costs of providing fine dining, the restaurant owner now must seat twice as many patrons in the same amount of time.  

 

What was once an outstanding business that focused on fine dining and customer service has now been turned into a business in the business of trying to get paid.

 

So, if you ever wonder why I don't bill insurance, one of the reasons is the bureaucratic nightmare you just read about.  Some of the other reasons are listed here: Why-no-medical-insurance-is-accepted-at-this-office Instead of billing insurance, we use the Honor Fee System which most people that care about their health and life love. which most people that care about their health and life love.

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