The $667 acupuncture visit that made the news and some thoughts from Dr. C

The $667 acupuncture visit that made the news and some thoughts from Dr. C

We have a crazy healthcare system that allows excess reimbursement but also incentivizes doctors to do things that may not be in your best interest.

This is especially true in healthcare where the data clearly shows that seeing a chiropractor or a physical therapist results in more satisfactory outcomes at a much lower cost for a painful lower back.  Apparently, x rays are overrated and MRIs are overutilized and may result in a medical procedure of dubious value that can actually do great harm.

Apparently, United Healthcare’s Optum health is the only one who has recognized this.   You would think that primary doctors would be referring to chiropractors more than ever, however, it is the patients who are self-referring and the doctors are not reading their own research apparently.  If they were, they would be asking to visit chiropractors who have great reputations in their community, meet them and refer to them.  Our office has done just this although we periodically are visited by physicians who have back problems themselves.

Then, there is, of course, the $667 acupuncture visit.  According to a reliable source, whose office is down the street from this multidisciplinary practice, they mainly cater to those who still have out of network benefits and plans that do not perform any due diligence on the bills that are paid.  The result is the teachers who have this plan continue to hear from management that their premiums continue to rise.

Of course, the norm is that most insurers under reimbursing doctors in-network and the dwindling amount of doctors who cater to the out of network insured folks often charge ridiculous fees for their time and treatment.

While this article in ProPublica blames physical therapists, acupuncturists, and chiropractors, the truth is that the insurer allowed this to happen and they have the data on who is charging outrageous amounts for the services that were provided.

Medicare solved the problem years ago by limiting the amount payable and chargeable for out of network provider services.  Other insurers such as Cigna have made a game out of it, using an outside company to unfairly reprice out of network claims.   The NJ state insurance plan created a limit of $35 for chiropractic visits and $60 for acupuncture visits out of network in a closed-door meeting, that had no input from anyone who would have been affected, which was unfair to those insured by the plan and the doctors who care for them. As you can see, there are two sides to this story and unfortunately, it is often the insurer who is behaving badly.

Insurance fraud takes many forms.   Again, insurers have reams of data and instead of constructively finding intelligent solutions to their problem billers, they pay the bill and hire someone to write an article like this.

Chiropractors, acupuncturists and therapists are not the problems here; the insurer is.   While there are always a few bad apples in any profession, this is certainly an extreme example of what happens when the payer does not do their job.

In network, many chiropractors are treated poorly and many have not had a raise for years by the insurers. Many are subjected to precertification programs which hinder care and add an additional administrative burden to the doctor, but add no value to the care provided in most cases.  I do hear this from other professions such as psychotherapists who also are overburdened by paperwork, certifications, and low reimbursements.

On the other hand, insurers have incentivized large hospital systems to get larger and become monopolies with plans such as Horizon’s Omnia.   Hospitals that were left out and made to be more expensive by tier 2 have since joined larger hospital systems which were tier 1 and we all pay much more for care.

While this may sound like a rant, the truth is, we all pay more for insurance because of insurance company policies and actions. The $667 acupuncture visit is merely a symptom of an inequitable system that continues to worsen, but it makes an awesome headline.

Check out the article in ProPublica below

What Happens When a Health Plan Has No Limits? An Acupuncturist Earns $677 a Session.

New Jersey’s health plan for school employees pays out-of-network providers virtually whatever they want. Dozens of acupuncturists and physical therapists earned more than $200,000 in 2018 from school staff alone. One brought in $1 million.

by Marshall Allen Dec. 19, 2019

Judging by the marketing, it would seem that the teachers of New Jersey have collectively thrown out their backs, pulled a muscle or pinched a nerve while engaged in rigorous educating.

Last fall, when teachers at about a dozen New Jersey schools returned from break, employees from Thompson Healthcare & Sports Medicine welcomed them with bagels and orange juice. The clinic’s owner also created an empathetic YouTube video titled “We Understand Painful Conditions Suffered By Teachers.”

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