When I go to the grocery store, I have to pay the cashier before I can go home with my groceries.
When I go to the movie theater, I have to pay the person at the ticket counter before I can go in to see the movie.
Why should it be any different with chiropractic?
Chiropractic is not in any way related to the medical profession. However, most people mistakingly think it is.
Chiropractic is about prevention. Keep the nervous system clear of interference. Get checked regularly to make sure no interference exists. If interference exists, via a vertebral subluxation, get it removed immediately. Pretty simple, pretty basic.
Insurance is for accidents, emergencies, traumas, etc. People don’t go to chiropractors for those things, they go to the Emergency Room.
Chiropractic is about taking responsibility for your own health. When you take responsibility, that also means financially, too.
Many chiropractors do take insurance, and that’s fine if they do. However, what is taught in chiropractic schools across the country and in many chiropractic trade magazines and articles is that if you do not take insurance whatsoever, the bottom line is that you will fail. That is the mindset I’m addressing.
This isn’t true at all. There are some very successful chiropractors I know who take nothing but cash payments for services rendered… and they are thriving, despite all the nationwide economic turmoil!
Here is a great interview with chiropractic advocate Bill Esteb speaking on some of this.
Enjoy!
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{ 11 comments… read them below or add one }
It really is about educating the patient that there insurance card is not a credit card and they are responsible for paying for their care. I follow Bill’s patient education and his ideas, he is one the smartest guys in the profession. Also, from a practice stand point chiropractors have to figure out what make them unique from all of the other chiropractors in your town, why should they come see you and pay out of pocket for your care Vs a $10-20 co-payment.
Great video, Brandon, thanks for sharing it.
Nice post, Brandon.
I’ve tried to explain this to many people, but they just don’t (or more accurately – WON’T) accept that it can be done. Our clinic is basically 100% cash (we’ll accept assignment with MVAs with written confirmation from the insurance company), and that is in a system where the medical care system is fully publicly funded!!! So our patients come in to PAY and see us in our clinic when they could be going to an MD for free!
If that doesn’t tell you that a cash practice can survive and thrive on PURELY upper cervical philosophy and care (no modalities, pillows, supplements, or anything other than NUCCA is offered in our office), then I don’t know what can.
People who get well from the Palmer upper cervical chiropractic I provide in my office often ask me why there aren’t more chiropractors who do what I do. I tell them that it’s because when chiropractic became covered by insurance in the 1960′s chiropractors stopped doing what was best for the patients and started doing what would get covered by the insurance company. The first job I took as an associate when I got out of chiropractic college in the early 1990′s required that I provide sloppy diversified manipulation and every person got a heating pad because the insurance company paid $20.00. So the doctor got an extra $20.00 on each visit. It was necessary then to give the heating pad. Then in the later 1990′s when the insurance company’s stopped paying for heat, all of a sudden the patients did not need heat anymore. I have run a cash practice most of my career and am full cash now. If people have to pay out of pocket they usually only want the one adjustment that is going to help them get well. That is why upper cervical chiropractic is making a come back. Having a cash practice has made me a better chiropractor. It has made me work hard to perfectt my skills as an upper cervical doctor. I have learned one law about insurance and that is, if the patient starts out there care on insurance they can never be converted to cash pay after their insurance runs out. 17 years of practice has taughtt me that.
Rich Doble D.C.
I love that Bill refers to his body and our bodies as “Temple”. I typically talk about someone’s body as their temple as well, where we should love it, nurture it, take care of it, and decorate it.
The insurance thing is quite confusing. As a new Doc, I am constantly bombarded with people, patients or insurance companies, who try and get me to take insurance. Our health is out largest investment and the more we take care of it, the less we have to invest.
Great article Dr. Harshe. Thanks!
This is a good article and equally good concept. I accept the idea of paying for service before getting treated. However, what about the needs of the patient? For some of us who absolutely love Chiropractic care and thrive on it, we cannot afford to pay the high prices of care without insurance. Without health insurance, I would have to go without Chiropractic…or go every month or two, while risking worsening health and added stress. For physicians to not use insurance, I say great. I do think it is a selfish mindset to not consider the needs of every working man…not just the needs of the people who can afford care at your clinic.
People who have terrible ailments, who are suffering, will pay any price to get better. Upper cervical is different in the sense that you don’t have someone coming in 3x/week for a year like a lot of chiropractors. People come in and typically find their problems resolving very quickly.
All doctors who accept only cash will provide the patient with a receipt and the code that they can send in to insurance and get re-imbursed themselves. Insurance companies, more and more these days, are starting to increase deductibles and co-pays to the point where, even if you have insurance, most people are forced to pay cash anyway. Insurance might cover chiropractic for you now, but it’s only a matter of time before it doesn’t. Blue Cross Blue Shield is the standard bearer in the insurance world… they’ve stopped paying for chiropractic. It’s only a matter of time before your insurance follows suit.
As far as chiropractic being too expensive, here’s an example. Someone with low back pain that elects for surgery, especially with increasing deductibles and co-pays, is looking at paying $10,000-$20,000 out of pocket, at least. I charge $600 for 6 weeks of care. Which is higher? When the alternative to what I do is drugs and surgery, I am always the cheaper option.
I want to help as many people as I can. But what I do has a value, and is not to be given away for free. It’s called a fair-value exchange. I put in a lot of time, effort and money to do what I do, and what I do absolutely helps people. When you put in that kind of work, it is a basic law of life that you get compensated fairly. I want my compensation from the person I’m providing the service for. Not some 3rd party payer that will take 45-60 days to pay me, and then when they do pay me, they will try to pay me less than what I’m requesting. This is absolutely what is happening nowadays, and not just with chiropractic. MDs, DOs, and PTs all experience the same troubles.
Excellent article. Interesting choice of video accompanying the article. Bill Esteb points out that the medicalization of chiropractic is the biggest obstacle to widespread acceptance and utilization of chiropractic. He incorrectly blames this on chiropractors, who “fell for it” after insurance “began to cover chiropractic”.
I agree this is a major problem. But it is certainly not the fault of the individual chiropractors. It was the result of the actions of the ACA, through their CCE subdivision, forcing basic science curriculum into the chiropractic colleges. This in turn allowed the medically leaning segment of the profession to take over chiropractic education. The result was accreditation, which led to government loans to fund tuition. This same faction was then able to push for insurance coverage and Medicare coverage of chiropractic, albeit for a very narrow, limited, medically defined type of chiropractic care.
This limited version of care (a medical diagnosis, subluxation correction to eliminate the symptom, dismiss from care) was acceptable to the AMA run Medicare and insurance companies. It fit well with their overarching goal of “contain and eliminate”.
What was sacrificed was: our ability to provide a chiropractic education, opposed to a medical education; the ability for chiropractic to remain vocal critics of the medical model; the ability to present chiropractic to the public as something separate and distinct from the failing/failed allopathic model.
The reason I bring all of this up is that you need to be cognizant of who and what you put out there in an effort to advance your thoughts and ideas (and I happen to agree with most of what you write).
The DC interviewing Bill Esteb has several other videos on YouTube. This one, titled Chiropractic 101, I find particularly appalling, as Dr. DeFabio appears in his white lab coat with a stethoscope around his neck:
http://www.youtube.com/watch?v=mRpN5sJ4au4&feature=channel
The biggest challenge facing the profession today is a lack of a clear identity. There are actually two separate professions. One group would like to be a welcome part of the allopathic medical model, providing back and neck pain “treatment” and referring back and forth with their medical brethren.
The other would like to see chiropractic advance and grow as a separate and distinct profession that does something other than participate in and duplicate the failed medical model.
All those that fall into the latter category need to pitch in and help if we are to achieve the goal, which necessarily involves divorcing ourselves from those with the former, conflicting goal.
“Chiropractic is about prevention.”
-Brandon Harshe
“The purpose of this work is to get sick people well.”
-BJ Palmer
These two ideas are diametrically opposed.
BJ said those words time and again. To get a sick person well is not preventative. Even if all you have is a thermograph showing asymptomatic nervous dysfunction, that person is CURRENTLY ill. The subluxation is the one and only ailment/diagnosis of the chiropractor.
Would you ever adjust a patient who showed no sign of subluxation to “prevent” a subluxation from occurring? Of course not.
Exercise, nutrition, and meditation are preventative. Upper cervical chiropractic is not.
Most patients who enter an upper cervical office are really suffering. We take on the responsibility of improving their condition with sincerity. This work born out of BJ’s desire to help these people and the “vacuum created by the failures of medicine” (BJ Palmer).
General chiropractors (the “straight” ones, not the wanna-be PT’s or DO’s) like to work in the realm of asymptomatic patients. When you are grossly manipulating spines without really improving autonomic nervous function, it’s a good thing you don’t take on any quantifiable responsibility. This is not what BJ had envisioned. (At least the PT- or DO-type “chiropractor” is taking responsibility for helping that frozen shoulder.)
Our work is real. Our results are undeniable. Our work is in the trenches with people who are truly suffering and haven’t been helped by traditional methods. Our work can and does help the majority of these people. Our work can hardly be described as “preventative”.
Brandon, I respectfully disagree.
Kyle, I completely see where you are coming from, and I would agree with what you’re saying to an extent.
If you catch someone in the early stage of dis-ease or when a subluxation first occurs i.e. physical injury, and then remove the vertebral subluxation, and they get well, how is that not preventative? You’ve prevented a full-blown condition/disease from occuring.
Someone who’s been subluxated for a day will not be nearly as sick, usually, as someone who’s been subluxated for ten years. Remove the day-old subluxation, and sickness and disease has been prevented from ever developing. Remove the ten year old subluxation and a sick person gets well.
Both are not diametrically opposed, just appropriate for different time periods in which a subluxation exists.
Insurance is just that, for emergencies. Most DC’s should have cash based practices anyway since most insurances have these high deducatables and only contribute a certain amount if any. People who value what you do, will always find away to pay.
Marco, D.C.