Insurance Troubles – Solutions?

Insurance Troubles – Solutions?
November 10, 2016 Jennifer Rowe

Is Health Care Insurance Really Going to Take CARE of You?

By Dr. Jeanie Czerminski

Insurance has been a headache.  No; let me rephrase that – Insurance has been a nightmare.  I’m not talking just as a Provider.  I’m also talking about the consumer side, too.  As Consumers, we have seen patient’s benefits declining significantly over the past year or two.  Consumers are paying higher monthly premiums – sometimes monthly premiums are more than your house payment.  And, deductibles have gotten huge; it’s not uncommon to see $5,000, $6,000 or even $7,500 deductibles or more.  Plus, insurance companies are not covering as many services as they used to.  So, what does that mean?  It means that there are more out of pocket expenses.  Insurance companies are denying even some of the most basic services and prescription medications.

Let me tell you about our experience on the consumer side.  Our 16-year-old daughter has Type 1 Diabetes.  She has had this condition for over half of her life.  She has to inject insulin multiple times a day just to stay alive.  I thought I purchased a good policy from a well-known carrier this year.  Turns out this policy isn’t worth much at all.  I went to get her prescription filled last month, then, I received a letter from our insurance company saying that they filled a courtesy prescription but, that they would no longer cover her insulin, as it is “not medically unnecessary.”  Are you kidding me?  (They wanted our daughter to use a different kind of insulin – one her doctor didn’t want her on)  Her Doctor appealed.  I appealed.  The insurance company came back and denied our appeals and furthermore said the appeals were not going to be expedited, and that the insurance company would have 30 business days to respond.  I appealed again last week and haven’t heard back.  Oh, and this insurance company canceled this policy as of Dec 31, 2016.  I now have to find another insurance plan.

On the other hand, on the provider side, when we get a new patient or your insurance changes, we call your insurance company and get a verification of your benefits.  We ask specific questions, such as “Does this policy cover certain codes, Do we need to get a Pre-Authorization?”  The Insurance company has a Disclaimer when we call that basically says anything the Insurance company tells us may or may not be true and we can’t go back and appeal because they gave us this disclaimer.  We can spend up to an hour or more on the verification, then we let our patients know what their expected benefits should be and let them know up front what their out of pocket costs will likely be.  Then, we submit the claim.  We have to wait anywhere from 14 days to 30 days to get the Explanation of Benefits.  We may or may not get paid.  We have been denied payment on many, many patients this year based on loop holes that the insurance companies have created.  If we appeal, we then have to wait another 45 days to find out if we will get paid.  How many of you work and don’t’ get paid for 2 ½ months, if AT ALL?

Did you know that Medicare guidelines do not pay for Preventative Care?  And most commercial insurance companies follow Medicare guidelines. There is a rumor going around that Medicare will soon not pay for knee replacement surgeries, and they are now additionally restricting certain procedures after age 80.

So what is the takeaway of all of this? Take care of yourself now while you can.  Degeneration only gets worse.  Invest in yourself before it’s too late…  More people spend more money on maintenance on their cars than they do for their bodies!  You only have one body, and you can’t replace it.

We here at Advanced Integrated Medicine / Back To Health Chiropractic realize that your insurance plan may not be what you expected.  With that in mind, Dr. Drew has reduced his fees for his adjustments for our self-pay patients.  We have gone back to our original fees from 1995!  Your adjustments are now only $40!  We hope this will help you, and we look forward to helping you keep your health a priority!  Call us at 210-599-5970 for a free consultation.


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