Are we “in network” with Blue Cross, in network with Aetna, in network with Cigna? Of course we are. Well, at least we used to be. To be an Asheville chiropractor “in network” in the big policies like BCBS, Cigna, Aetna, etc brings lots of patients into our office. After all, you want to see a doctor who is in your insurance network right? Not necessarily, especially for chiropractic care. Read below to find out why not.
In this example, the patient pays the insurance company. However, it is the doctor and the insurance company that have the contract that dictates the patient care. This harms the doctor patient relationship because the doctor may not be able to give the patient what they need.
In this case the patient/doctor relationship is optimized. The contract is between the patient and the insurance company, As it should be. There is no contract between the doctor and the insurance company. Doctor prescribes best care. Patient decides if they want the care. Patient pays insurance company. Insurance pays patient.
The term “In network” as used by insurance companies, is basically a COST CONTAINMENT strategy for the insurance company. As an in network preferred provider for Blue Cross for example, we had to sign a contract each year in which we agreed to limit procedures and visits in order to cut costs for the insurance company. Does that sound like it is in the best interest of the patients? We did not think so. What this means is even though your actual Blue Cross insurance policy benefits may say you get “20 chiropractic visits per year.” In reality your “in network” doctor is obligated by their contract with your insurance company to limit those visits. Blue Cross for example, required us to maintain a 6 visit YEARLY average per patient!. We received a monthly report and if we went over this limit, we were subject to audit or repayment of our fees back to Blue Cross, or be kicked out of the network.
If you are a chiropractic patient and your policy says you get 20 visits per year and your chiropractor tells you they can only bill 6 for you and you are in pain, how would you feel? Most of out patients did not like this one bit and it was very hard for them to understand, especially if they clearly needed more visits.
The visit limit is just one example of how preferred doctors are limited and controlled. Basically someone in a big office who has never met the patient is telling the DOCTOR what they can and cannot do for you. Telling them how many visits you can be seen . This is independent of what you may need or WHAT YOU HAVE PAID FOR IN YOUR INSURANCE PREMIUM.
YOUR CO-PAY keeps going up right? In fact, most co-pays are now more than we charge for our office visit. Therefore, if you have a normal co-pay, you functionally do not have chiropractic benefits anyway! Let’s file the term “in network” in the “useless” category. Take a look at the diagrams below.
The bottom line? What does this mean for you?
Your insurance coverage may actually be much better for chiropractic care if you see an “out of network” doctor, send the bill to the the insurance and get reimbursed. You lose the short term up front advantage if you have a really cheap insurance co-pay, (few people do anymore) but it is only a short wait before you should be fully reimbursed for the visits you really need. This allows your doctor to provide the care that you and the doctor feel you need, not some accountant in Charlotte or Chicago. Give our office a call for great care and helpful assistance in getting full benefits for problems you really need care for. Any visits billed to Blue Cross or any other insurance company must still be “medically necessary” as most insurance does not pay for chiropractic “maintenance care.” There are still strict ethics in insurance billing. But, if you have a real problem that requires more than some arbitrary visit limit imposed by a stranger working in a corporate office, we can help you can get the full coverage you really need. We have chosen this route in order to better serve our patients. We hope you will agree. Call us if you have any questions and see how we can help.
828-298-0011
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The OMsource Mission
To guide and inspire my clients on a path to their highest potentials by improving their physical, emotional-mental, and spiritual wellbeing, empowering them to create the best possible life for themselves and to share that energy in the service of others.
Omri knows the human body better than any other health care practitioner I have ever worked with.
~Carolyn T
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~ S.H.
I have been coming to the center for nearly two years and Dr. Omri is fantastic! He helps me reduce stress, increase energy, eliminate pain and distress – which allows me to fully integrate my mind/ body/ spirit.
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Within 1.5 days, my body happily returned to its former state of well-being. Pain is gone and I am walking tall. I felt like I was moving on a cloud when I left. Highly recommended, don’t wait.
