It’s time for some real talk. Experts say you shouldn’t have regrets. But, I have a big regret. I regret ever taking insurance for payment in my sports chiropractic practice. After over a decade of making that mistake, I’m moving on. And, for many people this is shocking.
Before we go any further, I must give a quick disclaimer. Insurance can be useful for big ticket healthcare; like surgery and life threatening emergencies. For the purposes of this blog, we will be focusing on the smaller, more common healthcare needs we’ve all had before. The common misconception is that you must have insurance to receive healthcare, when in reality— you don’t. In fact, paying out of pocket can actually SAVE you money in many instances. If you have insurance, there exists a strong chance you have a co-pay (what you are responsible to pay on each visit) and a deductible (the minimum amount you must pay before your insurance actually kicks in and pays for your healthcare).
This varies from policy to policy, but is pretty standard. Since the Affordable Care Act passed in 2018, the rising cost of insurance coverage has driven many of these deductibles higher and higher each year…making it nearly impossible for individuals and families to ever meet their annual deductible before their plan year expires. This translates to most people paying a large sum out of pocket each year for their healthcare…AND paying a high monthly premium for the coverage. That is worth repeating—you are still paying cash for healthcare. What’s worse is that many times you have an insurance auditor making decisions on what’s best for your healthcare…denying claims or refusing to cover the charges for services their independent reviewers claim are not medically necessary. If you’ve ever had to deal with the frustration of a denied claim or medical service you needed and ended up paying for it anyway, then you know exactly what I mean.
Unfortunately, most insurance policies are written in a way that can be confusing…using terms and verbiage that are not commonly understood. Think about it…do you know what your deductible is? Or what your specialist co-pay is vs. the co-pay you pay for a primary care practitioner? What about your co-insurance?
In my experience, many patients were never told exactly HOW their insurance policy works. These terms like deductible, out-of-pocket maximum, co-pay and co-insurance were never fully explained and patients are often left confused and upset when they receive a bill in the mail after a simple doctor’s visit—or worse, a very large bill after a denied claim for a medical procedure. After all, you pay hundreds of dollars each month for your health insurance—you expect everything to be covered right? Unfortunately, that’s not at all how it works.
So now that we’ve outlined all of the flaws with using insurance coverage for simple, routine healthcare, what can you do?
While it may surprise you, not using insurance might actually SAVE you money and get you HIGHER QUALITY healthcare. I have a great story to demonstrate that in the next blog.
Now while I cannot speak for ALL healthcare providers, I can say that most providers have options for patients that choose to pay out-of-pocket due to no insurance or bad insurance coverage.
Here are three things you can do:
- Ask for the “cash pay” rate – no…this doesn’t mean you have to pay in “cash”, it means that you will be paying the provider or facility DIRECTLY for your care as opposed to having the charges billed to your insurance where THEY pay the provider. Most providers are happy to offer a discount because they know they’ll be getting paid upfront and save on the administrative cost associated with billing insurance.
- Keep your receipts for any money you pay for healthcare – this goes for co-pays and any out-of-pocket (OOP) contribution you pay as well towards meeting your deductible. You can expense any funds spent on healthcare on your annual income taxes (every little bit helps, right?).
- Ask for a super-bill – a super-bill is a document your healthcare provider can give you that gives an itemized account of each service or procedure performed and the diagnosis associated with it along with all charges and the amounts paid. You’ll then want to contact your insurance carrier (calling the number on the back of your insurance ID card is usually best way to do so) and ask how to submit super-bills for reimbursement. If the charges are covered by your insurance, you can usually submit these so that the amount spent can go towards your deductible and out-of-pocket.
In our office we don’t bill insurance for many reasons—namely we prefer charging a fair flat price for the services our patients need as opposed to having care dictated by what is covered by insurance.
Here are a few other reasons we feel this is the best approach to patient-centered care:
- You get guaranteed one-to-one treatment from the doctor
- Your treatment isn’t dictated by what insurance “covers”; no denied services
- We offer flat, fair pricing. So, you won’t get surprise bills later on
- Your care is individualized, which means fewer visits; less time and money spent
- You can use health savings accounts (HSA) and flexible spending accounts (FSA)
- Your visit cost may be less expensive than your insurance co-pay
- You’re not limited by what doctor is “in-network”, so you can choose who is best for you
- Your treatment costs may be tax deductible
- You may be eligible for discounted treatment
- You are in-charge of your own healthcare needs!
The moral of the story is this: Get to know what your insurance policy covers and what it will cost you. Always ask for the cash price for a medical service you need, so you can compare and make the best choice for your situation.
