This original article was featured in the May 2023 issue of The American Chiropractor

Did you ring in the new year to verify patient insurance benefits? For a lot of us, this task is tedious and boring. And to top it off, we’re seeing deductibles at an all-time high and copays that are higher than the average adjustment charge! 

When consulting with practices about this topic, they’re disheartened when insured patients are not experiencing the full benefits of chiropractic. They can’t afford the high out-of-pocket costs associated with using their insurance and more and more doctors are fed up with the low reimbursement rates.

Super high deductibles, which your patients may likely never meet in your office, could be a roadblock that prevents them from enrolling into care or causes them to drop out of care when their insurance benefits are exhausted. It’s frustrating, isn’t it?

So how can you combat these high out-of-pocket costs while making care affordable for your patients? In this article, I’ll review a couple of strategies to increase patient enrollment and retention for insured patients.

Handling High Deductibles & Copays

Some patients may have great insurance coverage, but many are electing to become self-pay patients by opting out of you filing their insurance. Why? Because it’s usually less expensive. So how does this work?

Thanks to HIPAA/HITECH regulations, you have the ability to have non-medicare patients opt out of filing their health insurance. The only caveat is they must pay you in full. If a patient elects to opt out of their insurance, you should first have them sign an election to self-pay form. And should the patient meet their deductible and they want to begin using their insurance, they should sign a revocation of self-pay form. ChiroHealthUSA is a free resource for more information.

Offering the option for patients to opt out of filing their insurance as a non-required choice allows you the ability to make care more affordable. Since you’re not filing an insurance claim, you can apply compliant discounts to those non-insured services. 

But making care affordable isn’t all it takes to increase patient enrollment and retention. Read on as we dive into the effectiveness care plans have on your patients and your practice.

Care Plans

Care plans are the foundation of patient retention. If you fail to place a patient on a care plan, you are setting them up for failure, and they’ll drop out of care prematurely.  Unfortunately, the challenge many chiropractors and their team face is not knowing how to properly build a compliant care plan.  Many will make the mistake of trying what their colleague down the street is doing without realizing that it may not be legal.

The biggest area of non-compliant care plans is discounting. For example, you could get into hot water if you’re discounting or waiving copays and deductibles or giving too high of a discount on your services. It doesn’t matter if you’re a cash-based practice or not, there are rules and regulations that need to be followed. Be sure to connect with a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA, especially when you’re providing discounts greater than 15%.

Building care plans that incorporate all of the patient’s financial responsibilities for insured and uninsured services along with any discounts is the easiest way to ensure that your plans are compliant. Cash Practice has a robust Care Plan Calculator that makes putting this all together easy while integrating your own prompt pay and/or DMPO discounts.

Additionally, patients who are presented with a care plan and know the game plan for their treatment are much more likely to start and stay under care.  There are no hidden surprises for them, and it allows them to see the value of your care. 

Think about it yourself.  Would you rather see a doctor who says, “Let’s get you started and see how you do…”

Or, a doctor who says, “Based on my years of experience taking care of patients with similar findings, I anticipate that your care will take X months.  Every month, I’ll re-evaluate you; as long as you’re progressing as I anticipate, this will be the plan.  If for some reason, you’re not progressing as I expect, we’ll re-evaluate and make any appropriate changes, even if that means I have to refer you somewhere else.”

I want you to really think about this.  Do you want to see a doctor who is confident in their recommendations and has a clear plan?  Or do you prefer the doctor who has no real strategy?

If you selected the doctor with a plan, you’re not alone.  In fact, the vast majority of people agree with you.  Not having a plan makes it very difficult for your patients to hire you for more than just pain relief.

If you’re a chiropractor interested in helping people with long-term care, then failing to present a plan of care is the #1 roadblock to doing so.

We find that when presenting a comprehensive care plan to a patient, it’s best to offer them three payment options:

• Monthly payments
• Down payment with smaller monthly payments
• Prepayment

If you have been waiting for patients to exhaust their insurance before putting them on a care plan, you’ll likely find that that’s when patients tend to drop out.They’ve been used to paying copays, and now they’re being asked to pay more. However, by putting patients on a care plan right from the start that includes all of their costs for copays and uninsured services, they won’t have a new purchase decision to make when their insurance is exhausted.

The best practice for creating care plans is to include all of the patient’s financial responsibilities whether they’re using insurance or not. Then apply compliant discounts to non-insured visits that give affordable payment options, which incentivize people to enroll in care. 

Patients love the fact that all of the services and fees are clearly listed. They know exactly what to expect during the course of care, and even better, they don’t have to be asked for money when the insurance benefits are exhausted! The best practice for collecting their recurring monthly payment is using a PCI-DSS compliant payment software to automate how money is collected. By removing the thought of money, you help create a frictionless payment experience in your practice that allows you to focus on being of service.

You and your team will love patients being on care plans too! The money has already been handled upfront, patients are compliant with their treatment plan, and you have more time for patient care and education! 

Many things go into building patient retention. However, the most important factor is creating compliant care plans that patients can easily say yes to.  And these compliant care plans should incorporate both insured and non-insured services right from the start of care. The end game is to help as many people in your community receive chiropractic care. Make it easy and affordable while also untethering the rope insurance may have you knotted up in.