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Health insurance companies, to many chiropractors, represent significant opportunity for practice growth.
Patients who can use their benefits at a chiropractic practice will likely owe less out-of-pocket, allowing their physicians to charge patients less and still maintain strong revenues. Insurers may also serve as a referral source by encouraging patients to use in-network chiropractors.
Insurers try to maximize their own profitability whenever possible and legal. Sometimes, this fundamental business reality means that the interests of insurance companies and chiropractors are in direct conflict with each other. Chiropractors who do not understand how insurance companies operate are at a disadvantage.
By becoming more insurance-savvy, your practice can make this a fairer fight. Here are five facts about insurance that may just transform your business.
1. You can join major insurance networks
In the past, many major insurers were skeptical about chiropractic care. Coverage was minimal or nonexistent for many patients. Chiropractic patients largely paid their bills out-of-pocket and had limited options for reimbursement from either public or private insurance. As a result, patients who could not afford chiropractic care mostly went without.
Now, most major insurers are searching for more healthcare solutions. The emphasis by health plans is changing and beginning to incorporate more natural, holistic treatments. Wellness is becoming more important. As a result, chiropractors now have more reimbursement options from major insurance companies.
2. You can reapply to networks
Once you start joining major insurance networks, it actually becomes easier to gain acceptance with other insurance companies. A rejected application is not the end, either. You can continue to reapply and appeal your application’s rejection. If you are reapplying, try to make a good case for the quality and value of your care for patients.
3. Providers can negotiate billings
You are not necessarily stuck with whatever reimbursement the insurer wants to pay you. Providers often have more leverage to negotiate more favorable terms than they realize, and it may certainly be worthwhile to try negotiating with insurance companies. The result can be a higher reimbursement, meaning less overall that the patient is responsible for paying. Your patients will probably appreciate your efforts, too.
4. Appealing insurance claims is possible and often successful
While the process and applicable laws do vary by state, denied claims are eligible for appeal. Appeals by patients may succeed, so some insurance companies probably hope that patients remain unaware of this right to appeal.
5. Chiropractors may be able to join Managed Care Organizations (MCOs)
There are different types of MCOs and each type is structured differently. Before joining one, be sure to review their contract thoroughly and ask questions about how the MCO operates. These organizations may be worth joining, since you will then become a preferred or approved provider serving a particular group of patients. Depending on the MCO and what they offer, chiropractors may join and become eligible to serve their patients.
Cooperation with insurers may help your practice to grow and thrive beyond what cash-only practices are able to achieve. Depending on how you choose to operate the business side of your practice, insurance reimbursements could become a bigger portion of your revenue or serve as a supplement to what your self-paying patients contribute.
Medicare and Medicaid are also viable insurance options for chiropractors, so be sure to look into becoming eligible for these reimbursements if you are interested. Doing your own research will help you obtain customized information that fits your practice and your needs.
About ACOM Health
ACOM Health is a leading provider of innovative software and services developed by and for chiropractors. We are a division of ACOM Solutions, Inc., a 34 year old U.S. based corporation that supports thousands of businesses and healthcare organizations worldwide.
References
¹NCMIC. “How to Join Major Networks.” MCMIC. https://www.ncmic.com/prc/insurance/third-party-payers/how-to-join-major-networks.aspx. Accessed October 2016.
²Gesme, D and Wiseman, M. “How to Negotiate With Health Care Plans.” Journal of Oncology Practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900878/. Published July 2010. Accessed October 2016.
³Healthcare.gov. “How to appeal an insurance company decision.” healthcare.gov. https://www.healthcare.gov/appeal-insurance-company-decision/appeals/. Accessed October 2016.
