The Difficulty with High-Deductibles
A close friend recently shared his frustration with rising healthcare costs. He and his wife are self-employed with six beautiful children (ages 5-20). They pay almost $1,000 per month in insurance premiums and have a deductible of $10,000. In January, he had a sinus infection that he self-diagnosed as a head cold while traveling for business. He took over-the-counter medication for a week before his wife dragged him into the local urgent care clinic. He was diagnosed with a sinus infection, an ear infection and an upper respiratory infection. After receiving a couple of shots and prescriptions, his total out-of-pocket expense was $1,200.
To keep premiums affordable, more families, like my close friends, have transitioned to high deductible insurance. In fact, the number of families that opted for high-deductible plans rose from 20% in 2014 to 29% in 2016, with deductibles so high that, short of having an appendectomy in 2017, it is unlikely they will meet their deductible this year. The average actual charges for a routine office visit billed in chiropractic offices across the country can be around $106. It is easy to understand why many patients never return after the initial visit or report-of-findings.
Patients are looking for access to affordable care in your office, but before offering a “cash” discount, remember that offering deals to patients outside of a contractual discount (PPO, MCO, DMPO) can put your practice at substantial risk of fines and penalties, not to mention the fallout that can occur when your insurance patients find out that you charge them more than you do your cash patients. Never a pretty situation. In many states, the law prohibits you from having “dual fee” schedules or charging higher fees to insurance payers than to patients who pay cash, even though the cost of billing to insurance carriers is certainly more. Additionally, when it comes to offering discounts (inducements), we must be mindful of the OIG regulations that prohibit patients from receiving a gift of more than $15 per item or $75 on annual basis.
The great news is that Discount Medical Plan Organizations offer patients with high deductibles the benefit of lower fees than they might have WITH their insurance. And there are no monthly premiums. Providers who offer these types of memberships to their patients give their patients the same types of discounts that insurance carriers have negotiated for those same services. Many times, the discounts to patients are the same, or lower than the co-pays they are accustomed to paying for their treatment with robust insurance plans. If you are looking for a way to help your patients who will likely never meet their deductibles or have a limited number of visits under their plans, consider becoming a provider with a simple, compliant and profitable financial policy offering discounts through a DMPO.
About the Author
Dr. Ray Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA, a Discount Medical Plan Organization. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation, and compliance. He has served as president of the Mississippi Chiropractic Association, former Staff Chiropractor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. You can contact Dr. Foxworth at 1-888-719-9990, firstname.lastname@example.org or visit the ChiroHealthUSA website at www.chirohealthusa.com. Join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind. Go to www.chirohealthusa.com to register today.