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  • Writer's pictureDebra Lapiers

Why don't you take my insurance?

The numerous drawbacks are usually unseen by patients.

Medical insurance is not a group of concerned doctors determining what’s best for patients. Often insurance doesn’t even cover the minimum services necessary and is not what doctors require or recommend. This often causes patients only to do what’s covered rather than the doctor's recommendations. In turn, doctors treat patients according to what insurance will cover.

Being in the insurance network means providers must follow the insurance company's rules.

One common practice is that service pricing is not at the provider's discretion. Insurance companies pay at their discretion and when they want to. It’s normal for the provider to receive payments months or even years after the treatment and only a fraction of what was billed. Due to only a percentage being paid, providers often increase their rates to obtain what was due to cover their costs. A provider may charge $200 for a service that would have cost $100. This is done to recuperate 50% from the insurance company if that is all they pay. Since the rate is $200 it can not be adjusted for underinsured or patients without insurance. The rate is higher for all due only to insurance rules.

Medical insurance drives up the cost of procedures in the US, which is why procedures cost more here than in other countries. Drugs manufactured in the US and exported to Canada cost considerably less in Canada for this reason.

Insurance companies require additional paperwork on most billing. This is time-consuming and usually causes the employment of personnel to handle and monitor insurance claims and changes in insurance rules and processing. This additional cost is passed on in the treatment costs, or the provider excepts lesser payment due to overhead.

Patients perspective:

- The practitioner is viewed as the bad guy for not taking insurance.

- In-network provider: Means the cost of a co-pay and everything is covered.

- Additional acupuncture recommended but not covered by insurance is expensive. Following the guidelines of the insurance company, as if they know what’s best.

Acupuncturist perspective:

- Not in Network: Questioned as to why and told they should take insurance. Told they could make more money and in reality, they would lose money and have additional expenses.

- Prices will be increased to cover additional costs or the acupuncturist will accept insurance patients as a business loss.

- Patients will follow insurance recommendations and covered treatments rather than the guidance of a trained acupuncturist. Acupuncture can be viewed as ineffective as a result of insurance guidelines not covering the right amount of treatments for a full recovery.

- Prices will be bloated due to insurance costs and additional treatments will cost patients more or deter patients from getting the treatments they need.

- Insurance dictating the number of treatments will mean patients will leave before a full treatment course is completed. The practice and acupuncturist will both be viewed as ineffective as a result.

- No latitude to change pricing if deemed necessary and all pricing is fixed for all patients. Many practices offer a cash time of service payment rate as a way to bypass insurance fixed pricing.

We offer super bills which are what insurance companies use to process claims. Patients can attempt to be reimbursed for their treatments. Patients will likely be given reasons as to why they are not fully reimbursed for an out-of-network provider but the truth is reimbursement will likely be exactly what an in-network provider would have received.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protect patient's medical records from being disclosed. Reviewing the law shows there is more of a focus on insurance billing information, insurance claims, insurance procedures, and in-network provider claims. The law was designed to protect insurance companies as a byproduct patient information was protected as well. Full disclosure of medical insurance's lack of payment to providers would be embarrassing if it were made public.

Chinese Medicine and Health

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