The Truth About Insurance
Lately, we have been having endless conversations with patients, friends, and colleagues about insurance. You may be thinking, of course you are, you practice medicine. But let me be blunt – in no period of my clinical career, reaching towards two decades, have I ever had to field so many specific questions and be as concise for everyone. So, it was clear to me that I needed to write a few paragraphs on this topic.
The Little White Lies of Health Insurance Companies
Take a moment to think about your own employment. Does your boss dictate the parameters of your work and control how much you get paid and when you will get paid? Of course they do, they are in charge of creating an excellent product or service within a profitable business. Are they also required to pay you the set amount in your contract so you know exactly how much will appear in your bank account each week?
Private practice clinicians are faced with uncertainty every day. If a clinician is in-network, they work for the insurance companies. Insurance companies decide what health concerns will be covered, how many visits per year a patient can get treatment, and how much the provider gets paid. It makes it very difficult to effectively care for and create appropriate protocols for their patients because they become beholden to the insurance companies with all of the strict parameters.
In-Network providers are beholden to insurance companies
Unfortunately, for many clinicians this decision is made even before they have started their clinical careers. They need to get started with their private practice and begin working. The insurance companies promise a load of patients with no marketing and endless benefits by becoming an in-network provider. So, providers sign a more than 100-page contract with each insurance company. What they don’t tell them is that they are going to pay them whatever they feel is appropriate, they can change that amount at any time, and they can put up more restrictions whenever they want to. And this contract ties them, nearly in perpetuity, to the company with no ability to negotiate later.
In fact, when a clinician wants to leave the contract, it is not as simple as putting in your two weeks. They need to fight the bureaucratic machine making pleading phone calls for their information to be processed, completing forms over and over- somehow there is never a record of this paperwork being received at all. But guess what, even if you can get to that point where they process the paperwork, the insurance company forces clinicians to keep treating their members for 3-6 months before they will remove your name from their lists. It is like signing up for the worst pyramid scheme where the products keep piling up in your garage and no matter how hard you try you cannot get out of this terrible deal.
How is this fair to people who have dedicated their lives to the health and wellness of their local communities?
Can You Survive on Half Your Income?
Let’s take a step forward. How do we all feel about stagnated wages for anyone? Do we think it is fair if people with 2, 3, 4 decades of experience are earning the same amount of money as they were when they were fresh in the field? No. Experience typically equates to making more. Also, the cost of living continues to rise and to account for that, most people get a raise every year or every few years. It would seem logical that insurance companies would take inflation and experience into account when paying their providers. Guess what. They do the opposite.
Did you know most insurance companies pay their clinicians significantly less today than they did in the 1980’s? And did you know that most clinicians had a dramatic decrease in reimbursement rates post COVID – a nearly 50% reduction across the board in the last 3 years. Let that sink in. With all the hits small businesses have taken and the dramatic inflation, we have had a 50% decrease in insurance payments since March 2020.
There Has Been a 50% Reduction in Reimbursement Rates in the Last 3 Years
Just look at Q2 2022 earning of major health insurance companies.
These companies are making record profits and manipulating the system to control the narrative and sell an image that by going in-network you, the member, are getting great care at a reduced rate – and I am here to tell you that is simply not the case anymore; nor has it been so for the past decade.
You, the member, have continued to pay higher monthly premium payments, higher co-pays and deductibles, while your benefit package continues to get worse. Meaning you have less care available. And with these worse benefits, doctors of all types, are leaving the insurance plans. They no longer will accept non-livable wages. This creates a scenario where patients cannot access the care they need.
Summary
How do we move forward? Well, likely there will be a major change in the health care industry in the next decade. Why? Simple. More and more people are getting wiser about what careers they want to pursue prior to investing into their education. With cost of education rising and medical reimbursement decreasing most clinicians are only going into fields that are not part of the insurance business model. In fact, this has been the trend in medical schools for more than a decade.
Very soon, all of us, will be looking for experienced clinicians and they won’t be there – there will be longer wait times, and terrible administrative experiences. Perhaps you have already experienced some of this. As a society we simply cannot assume that people will give up 10-15 years of their lives in higher learning and then get reimbursed so poorly.
Conclusion
Like so many other clinics, this is the decision that Garden Acupuncture has been faced with – do you continue to be treated poorly from the insurance carriers and be forced to accept $30- $80 for your services?
For us, the answer is no. With more than 40+ years of combined clinical experience (that is 20 years for each of us), extensive training with world renowned experts, and the ease of availability with our practice being open 10am – 9pm (6/week), we have decided to be direct - if you want the most dedicated, experienced, and trustworthy clinicians come to us.
Medicine of any type is about people. It is not a brand. We know our worth to our community and we have been providing that care continuously. We hope to meet you on your health journey and help you achieve your goals.