From The Trenches: Part 3

1)     If you decide to accept insurance, put some office policies in place that you stick to without fail.  I lost a great deal of money deferring to patients who insisted they had coverage and then walked out on unpaid balances because I had not verified coverage prior to their first visit.   Now, in my office, regardless of the amount of coverage my biller determines,  it is the office policy that patients pay in full the first visit or two in full until we receive back the first EOB (Explanation of Benefits) and see what their insurance pays.   We don’t know WHAT a carrier pays until we bill it the first time.  Often times, even if a patient has met their deductible, a carrier will find a reason to find some reason to deny a payment or two.  If a patient argues with me over this point prior to the first visit, then I refer them to another provider.  Period. 

2)     Consider using an ABN for balance billing.  An Advance Billing Notification is one way to not only protect yourself from unpaid claims, but allows the patient to determine which additional services they want for their session and to bill accordingly.  While some acupuncturists who practice community acupuncture or more of a TCM style, an HMO fee schedule may be fine. But how do you reconcile yourself to $40 for a 5-elemental or Japanese style acupuncture which usually is a longer treatment, 2-sided treatment, involving moxa and fukushin?

The truth is, you don’t.  My own acupuncturist said it best: “I am sick of filling the holes in the US health care system and not being compensated for it.”   In truth, many of us are practicing far beyond our original scope of practice, becoming primary care providers, including counseling, ordering labs, nutritional assessment, massage, managing toxic drug reactions and poly-pharmacy, and herbs that  we learned at the post­­-graduate level, well outside school.  90% of this is NOT included an HMO or PPO fee schedule.  The ABN was what allowed me to finally accept some of the HMO based fee schedules and build an a la carte practice.  Many of my HMO patients opt for higher copays to enjoy the benefit of Japanese style moxa, massage, or nutritional assessment, none of which is covered by their HMO.  I let the patient decide what aspects they wish to pay for and treat accordingly. 

When all else fails, remember a few things -

1)     You will make mistakes that cost you money, sometimes quite a bit.  This is a PRACTICE – you will learn as you go.  Sometimes you have to pick your battles.  No amount of money is worth my peace of mind any more and the longer I am in practice the better I get at letting this go.  Nothing, in my experience, uses up the desire to serve more than doing it constantly without compensation (thus living below the poverty line). 

2)     You will not get paid on many cases.  At this stage in my practice, the reality is that I write off a few thousand annually in unpaid claims, due in part to mistakes, unscrupulous companies and their practices, and clients who skip out of payments.  I won’t deny that this has been a difficult journey, saying c’est la vie to a case when I don’t get paid, but I get better at it every day.  Releasing the bad case opens me to the next client who pays fully and gratefully enjoys all that I have to offer. 

3)     Billing is a SERVICE which you are not obligated to provide.  Many of my patients pay my full fees, regardless of their coverage and I bill for them as a courtesy, particularly if their chief complaint in internal medicine or fertility and we know a carrier will not cover treatment.  For carriers who are problematic, I issue a superbill and let them deal with it.  In the end, the patient has a relationship with the insurance company, not me. 

I have learned that patients have no understanding of their own insurance coverage.  Southern CA where I practice is the most heavily infiltrated region in the country with regards to HMO coverage, and there is a great deal of entitlement on the part of some patients who have been lured into thinking that every aspect of their care requires nothing more than a $10 co-pay.  They have little understanding of the time, effort and hassles associated with trying to bill for their care.  That is fine, but I no longer feel obligated to provide this service for free. 

As practitioners, it is vital to protect ourselves from resentment, whether from clients or insurance companies.  Resentment is an emotion that eats away at satisfaction, regardless of clinical success.  Most of us are extremely idealistic and altruistic in their regard to helping patients achieve wellness and it can hurt when some patients have no more commitment to you than a copayment. 

I have learned to set boundaries that protect both my cash flow and my piece of mind, and it has ultimately resulted in both more joy and financial abundance in my practice.  My hope is that more of you will take the plunge into the insurance maze, with the hope that both your own practice and our profession prosper both medically and financially.