Disclosure: This article, in no way, has been created to insult the chiropractic or preventative healthcare profession. It is not a judgment on others' practices, just an enlightenment of the cost and time that goes into the current healthcare model on behalf of the patients receiving it. Also, the figures in this article are based on the latest current statistics from the Kaiser Foundation and the Census Bureau.
Touchy subject. I will do my best to make myself diplomatic here, but this is the type of thing that really gets to me. I can feel my left shoulder ache and tense up as I start to think about insurance benefits. Working in clinical practices that accept insurance for more than 7 years of my working life, I have learned the ins and outs of insurance plans for preventative care (and dentistry). Something that needs to be addressed is the fact that there is a large majority that have no idea how insurance actually works or how much money they are actually spending. I’m going to give you a simple breakdown. Our system is a broken one, and it’s high time we all understood it.
That was published in USA today. Chiropractors, massage therapy, supplements, etc. are big business. So where’s the majority of that money going? You guessed it! Here’s how. (this is for a single payer, not family, family stats are much higher)
In 2015, the average annual premiums contribution by the workers was $1,071. Premiums are what they call your monthly insurance bill. You know, kind of like cable or electric, but instead it just sits there. The median wage in the US per person is $26,695. That’s 4 % of your annual income before you even use any healthcare.
Next you have out-of-pocket costs such as deductibles, co-pay, or coinsurance. This is the amount you still have to pay after you pay your premium. So, if you are one of the 81% that have a deductible, you are responsible for 100% of the cost of your health care until you meet it. More money out of your pocket. The average deductible for a single person is $1318. That percentage out of your pocket just jumped to 8% of your income. You have not received a single benefit of having insurance yet.
Wait a minute... You still have to pay
After your deductible is met, 91% of you still have other out of pocket costs. That’s only for covered services, meaning their are still services you will be 100% responsible for. Co-payments average to be $24-37 per visit (office visit, not hospital stay). Co-insurance’s average to be 23-24% patient responsibility for services rendered (also office visit).
What does this have to do with Chiropractic and Preventative care?
The current health care/insurance model creates a specific design in Chiropractic offices that I am not proud to be part of. The idea is almost exactly the same as the traditional western healthcare model. First, exams are based on old orthopedic testing, that at best, tells part of the problem. You are then given some sort of care regimen that is designed to help you marginally feel better over long periods of time. Good, well-equipped chiropractors will throw the book at you.
Everything from electric muscle stimulation, cold laser therapy (which I happen to be a fan of), and ultrasound, acupuncture, massage therapy, rehabilitative exercises, etc. These therapies are really only appropriate for acute conditions, meaning acute musculoskeletal conditions. They should not be used long-term or in chronic conditions because they don’t help, and in fact, could be detrimental to the condition. While these devices can help in acute injuries, they do not determine or help to fix the problem, just merely help with the symptoms of injury. The care regimens usually also includes soft tissue manipulation. (Sadly, more times than not, this 10-15 minutes of massage is delivered by a person that has very little to no training in massage itself.) There is also usually an exercise portion to your treatment plan. These exercises, at most, are an effective way to create movement in a joint. However, they are not specialized to the specific issue at hand, so there’s no evidence that they will help the problem at all.
The True Cost
Ok, so examples are dragging on, I know, bear with me. It’s all relevant. Let’s take a look at some of the costs of these appointments and modalities. For all codes billed by any physician, Medicare has created a fee schedule, that determines usual and customary fees. The price quotes in this article will be based upon those fees.
For arguments sake, and for us to have a guideline to go by, we will say that the treatment plan we are discussing will include a chiropractic adjustment ($28.64-$53.71), e-stim ($19.33), soft tissue manipulation aka manual therapy ($30.08), and therapeutic exercises ($32.58).
Now, the total cost of one visit is roughly $135. This figure is not including initial exam, which usually runs between $150- $200. So, to continue with our math to cost plan an entire treatment plan.
Depending on the situation, the current model would recommend that you visit the office 3 times a week for 6 months. At some point the treatment will be re-evaluated, and a different visit plan will be discussed. Usually that becomes 1 time per week, and that may continue for another month, then be lessened to every other week for a couple months, and then once a month, for “maintenance.” Over that span of time you there has been $11,405 billed for your treatment plan.
Meanwhile, you may not even feel all that better, because the cause of your problem may not have been addressed, only the pain itself. (in a later article I will explain why this doesn’t work.) Now given the coverage of your insurance plan, your portion of this cost will be roughly, $2,737 if you are responsible for a coinsurance after meeting your deductible. If you are responsible for a co-payment, this figure look more like $3071.
At this point, let’s add this all up. According to average out-of -pocket costs for a single person for an average Chiropractic treatment plan, you will be paying somewhere in the ballpark of $5,126-$5,460 over a year's time, given that you continue to make minimal progress, and nothing else goes wrong. That means a whopping 20% of your total income. Then when you add in the time (time is money, after all) that you’ve spent in that office, probably about an hour per visit, we are looking at a loss of 83 hours and at the average salary that amounts to $1,154.
Grand total out-of-pocket to see a chiropractor, folks…. $6,280 - $6,614 per year. You might be wondering, how could that be? Like I said, this is a hypothetical model of a typical chiropractic treatment plan that involves physical therapy modalities, not including any courtesy discounts or supplies and supplements. Also, this amount is slowly over time leached from your pocket. It’s not like it comes out of your pocket all at once. We don’t usually do the math on these types of expenses because we need them, to feel better. So, now that you’ve got the skinny, what can you do about it?
How to Help Heal Yourself
There are a lot of things that you can do to keep yourself out of the doctor's office. I just want to give you some examples.
Eat well. We all know this, but it’s easier said than done. Take the time to shop for whole organic foods, and stay away from anything that comes in a box. The more nutrient rich dense your food, the better the body is equipped at fighting away illnesses and healing injuries.
Adequate sleep. Your body does most of its healing between the hours of 10 pm and 6 am, only if you are in bed. If you are up late every night chances are that your body is not healing efficiently and primed for more issues and injuries.
Exercise. You don’t have to do crossfit, or run a marathon, but with vast majority of us sitting behind a desk all day, making time for a 20 minute walk outside 2 times a day can improve mental, emotional, and physical health greatly.
Listen to your body. Pain signals are your body's way of telling your brain something is not right. Listen to them. Do not keep running if your hamstrings and IT bands ache, and then be surprised when you blow out your knee. Your bodies' signals are a part of a deeper consciousness . Follow its orders.
Consult experts. If something is going on inside you, do something about it. Do your research, and know who you are talking to. Just because someone has MD behind their name, or any other fancy initials doesn’t mean they know what’s best for your particular issue. Human health is a vast and complicated science. And, as much as we do know, it pales in comparison to what we don't. Do your homework, track your symptoms, and grill your physicians. If they can’t explain the treatment they are prescribing for you, run for the hills.
Why we do Things Deliberately Different
So, what does all of this have to do with me? I’m talking sh*t about the very industry I am a part of. Well, the truth is, I have set out to change it, even if it's just one person at a time.
At NeuroActive Health and Fitness, we are changing the Chiropractic model. Dr. Bruene and I have been working in this field for over five years, and one very basic reason we opened this practice is because we see all these flaws. We also stay informed on current research and change our practice models accordingly, to keep you out of our office and in your life. How do we do this?
Dr. Bruene and I have designed a unique approach to provide you with treatment that is Deliberately Different and based on the most current understandings we have on injury and healing. We believe that most people have the power to “fix” themselves and prevent injury. This is why Dr. Bruene created NeuroActive Fitness. Fitness classes designed by neuro-development principles that are accessible to anyone. We encourage all patients and anyone we meet to give them a try. At $30 a class we pride ourselves on giving people take-away knowledge and exercises that they can do in the comfort of their living room. Exercises that change your global functioning patterns. Which means you don’t have to keep coming back, just do them on your own. Come back when you want more, or more of a challenge.
In our clinic, we also take a Deliberately Different approach. When available, Dr. Bruene and I do all initial exams together, giving you two different sets of expertise on the problem. We have found that our method works fast and efficiently, because we won’t waste your time looking for your pain (usually you can tell us right where it is), but rather the source of it. We use neuromuscular re-education techniques to change pain within the brain, not simply addressing the associative symptoms. Our average patient will see us 1-6 times for one injury/issue, period, and usually walks away with more areas resolving than they even mentioned to us. Many patients will tell us later that not only was their issue resolved but some secondary issues as well. This also happens, because we treat the body as a whole, and recognize the brain as its commander. We treat what your body tells us to, not what your pain tells us to.
NAH&F and Insurance
So, what does this have to do with insurance? Well, in order for Chiropractic clinics to stay afloat and be profitable, they almost have to run on the model I mentioned previously. We don’t want to do that. Our care is first and foremost for people. That’s why we got into this business in the first place. We refuse to be underpaid for the work we do. We also refuse to overcharge, or create elaborate and unnecessary treatment plans to make ends meet. This is why we are doing everything we can to get away from the insurance based Chiropractic model. At the time being we are in network with several insurances, but be forewarned, we are in the process of getting out of network, if we are not able to get raises on our fee schedules. In order for our model to work, insurance companies have to be willing to meet us where were at, so we can get you in, out, and on with your life!
As for those without insurance, or those that have extremely high deductibles, we base our rates on what medicare deems usual and customary for our area. These rates may seem high in the beginning, but in the long run, they are much lower. At around $200 for an exam and around $100-$200 for treatment, that adds up to be $700-$1200 out-of-pocket for a treatment plan. The other benefit is you save time and are able to get back to your life much quicker. While the previously mentioned Chiro model is designed to keep you coming back, our hope is that you will tell your friends and family what a great experience you had, and how much better you feel, and that will keep people coming in our doors.
I hope you have found this article informative and enlightening, and I hope to see you in a NeuroActive Fitness class soon. P.S. mention this article, and your first class is on me.
Thanks for reading!
I’m Shelbi, and that’s The Rub.