Just because you have health insurance, don’t expect all your chiropractic or medical bills to be paid. With the recession, insurance companies are scrounging for ways to save money, and one of their top choices is to cut the level of reimbursement to the patient. Here are some of their favorite ways to do it.
1) Pre-existing conditions
If you have changed insurance companies recently, there is a good chance many of your health care bills won’t be covered this year, even though you are paying the full premium. Many insurance companies are being more stringent about what qualifies as a pre-existing condition.
If you have been treated for the same or a similar condition in the past year, they will likely call it “pre-existing” and refuse payment. This is true for health care and prescriptions alike.
If your old insurance company was paying for your high blood pressure medication, there is a good chance your new insurance won’t pay for your medication for up to a year after you join the plan. What’s worse is that you won’t know about these denials until after you have purchased the medication or had the medical procedure done.
2) Waiting periods
Some care is not covered simply because you have had the procedure performed before in the “recent past.”
One patient was instructed by her doctor to have a colonoscopy performed three years after her initial colonoscopy. She had it done, only to find out later that the $2,500 procedure wasn’t covered by her insurance.
The insurance company felt a person of her age should have a colonoscopy only once every five years. Even though her mother had colon cancer at an early age and her doctor recommended the procedure, the insurance company refused to pay.
3) Reduced payments
It's not just patients that insurance companies are wringing dry. Doctors, too, are feeling the pressure. A chiropractor recently complained that he was reimbursed a meager $8 from the insurance company for a procedure that his cash-paying patients pay $48 for. He can’t afford to accept insurance.
Patients, on the other hand, have to pay more of the bill each visit. Ten years ago, the typical patient paid a $15-$20 co-pay on each visit. Today, the average co-pay is closer to $35.
Insurance companies are squeezing both ends in order to save them money. Today’s bad economy will probably force that trend to continue. Before you schedule a health care procedure, ask your doctor's office to call the insurance company and verify that the procedure will be reimbursed.
About the AuthorDavid Kats is the owner of Kats Chiropractic Center in Tulsa, Oklahoma. He was voted Doctor of the Year by both Parker Research Foundation and the American Chiropractic Association in 1989.
Each year, Kats Chiropractic Center helps hundreds of patients in northeastern Oklahoma ease their chronic pain. Visit
KatsChiropractic.com to set up a free consultation today.
