Every day people call or come to our office with such high hopes for their health coverage, whether it be private insurance, Medicare, Medicaid, or many others. We were told that we are covered for everything as a blanket statement, with exception of deductible or co-pay. I love my senior patients, as well as all the others, and it boggles my mind how people can be lied to over and over again. Is it because the agent is a personal friend, a trusted celebrity, or a neighbor? Is it that we have been so brainwashed over the decades leading up to this purchase and it just stuck as a truth? Sounds familiar.
I want to clear up the fallacy once and for all. Insurance is a business to make money, not take little premium and pay out regularly if at all possible. Think of the national debt. Does it make sense to take in $2 Trillion and pay out $8 Trillion annually? This would create a problem that should eventually grind everything to a halt when nobody will give any more money, and the business would close. I will say that personally, I believe that Medicare should pay for everything for our seniors, but it has been an uphill battle for over 50 years and counting. They expect that a patient is given an exam and x-rays before treating them, but refuse to pay for them. This creates costs for the patient and the clinic. They also require a re-examination to be performed every 30 days or 10 visits, whichever comes first. Again, they do not pay for this and leave it up to the patient and the clinics. The clinics cannot do these services for free or else they are enticing people to come to them for the free services over another clinic. This is both a state and federal crime. There is also a question of how to best help the patient get better faster. Would it benefit the patient to get other extra services to help make the problem get better faster and more efficiently? Many times, the answer is yes, but the insurance does not cover anything other than 80% of the adjustment cost. The other PT-type modalities really can assist the doctor and patient, but again not reimbursed by the insurance. Cannot be done for free due to the state and federal laws mentioned above. So, it is very hard to make people understand where we are coming from.
Then comes the question of insurance limits. Many people have a plan that includes a set number of visits or services that they can be given under the policy. There is a new thing that has happened here in Florida especially called managed health care (MHC). This is where your company or group has decided in an effort to save some money, they will pay this company to watch the bottom line. They essentially protect the limits to the extreme. As an example, John Doe has insurance that gives him 35 patient visits, but the MHC will only allow the doctor to see them for 5 visits. Everyone is different in their speed of healing and repair, but this is ridiculous! If you know anything about the human body and exercise, you know that it needs time and repetition to actually work. Another example, nobody gets a six pack abs or tone legs in one to five visits to the gym. It is usually going 3 times per week for a few months before we truly see the difference. People ask why are we using this company. We are not. Your company or group is.
Lastly, we have third-party companies for the insurance companies. These companies are a gateway for doctors to be in network with a larger insurance or group of insurance companies. The average person in Florida does not realize that the insurance companies only allow so many doctors or clinics to be representatives in each market. As an example, when I began practicing here, Blue Cross allowed 8 chiropractors in their network for my area. The only problem was that 3 of the 8 were dead, 2 others had closed their offices or moved, and they haven’t opened up the books to add any more doctors in 30 years. So, this gateway is the only way a doctor can get into that network at all or they would have to be a cash-only practice which over 80% of doctors in the area are.
In conclusion, I hope that people wake up to what is going on around them and take charge of their own health. The insurance company is not about health or wellness, they are locked in on sick care. Don’t become another statistic, because the insurance wouldn’t let you do something to better your health!