Out-of-Network Doctors a better option?

Understanding insurance coverage is tricky. “In-Network”, “Out-of-network”, “Allowable”, “Write –off”….yada yada yada. The terminology alone is enough to cause a headache. All you REALLY want to know is how much is it going to cost to get rid of said headache? This is the million dollar question. And, depending on your healthcare plan, it can feel like it costs you a million dollars.

In-network vs. Out-of-network

In-network doctors have entered into a contract with a health insurance company to provide services for members at pre-negotiated rates. An out-of-network physician has not agreed to the discounted (cheaper) rates for chiropractic or medical care. As a result, patients will often forgo care with out-of-network providers because of the assumption that the cost will be higher with an out-of-network provider vs. an in-network provider. However, seeking out an in-network doctor is not always the best choice for you to get the care that you need.

Let me explain, an in-network doctor signs a contract.

This contract states the amount that the doctor can charge, what services he/she can charge for, how many services he/she can charge for, what hoops he/she must jump thru to get said visits. Whether you want to admit it or not, these limitations CAN and DO affect the care that you are receiving.

For one, what do you think happens if the in-network chiropractor feels you need a necessary therapy that would get rid of your headaches but your in-network insurance doesn’t pay for it? Do you think you still get it? NO. Not in most cases anyway. Instead, the doc bends to the insurance “powers that be” and does what they tell him that he should do. Yes, you’ve only had to pay the $40 copay each time, but do you recognize that you are in fact paying a much higher cost by not getting the treatment that you REALLY need?

Meanwhile, the out-of-network chiropractor, since there is no contract, is free to actually practice chiropractic and prescribe what he/she feels is in your best interest! Go figure!!! Your out-of-network chiropractor is not obligated to bend to the rules that the health insurance or their management organization has imposed on in-network chiropractors. And, if you’re really honest, these limitations are more about insurance profits than they are about the quality of care. This is why many chiropractors and medical doctors argue that out-of-network health care is better suited for patients who want the best care.

Why do people still flock to in-network chiropractors?

Although, you may initially have to pay more up front, what patients don’t understand is that because there are no contracted rates, many in-network services not covered will be covered when your receive out-of-network treatment. The reason? It’s easy for insurance companies to say no or restrict chiropractors under contract.

Choosing an out-of-network chiropractor, you not only get the care that you need and deserve, depending on your coverage, you often get paid back from the insurance company. Surprisingly, the patients at Corrective Chiropractic have reported that they end up paying less overall than if they had been in-network receiving the same care.

Out-of-network Insurance Pays YOU Better Than In-network Insurance Pays Your Chiropractor

When it comes to reimbursing chiropractors, insurance is quick to put up a lot of red tape barriers and drag their feet when they have to pay the provider for your chiropractic care. Most important, is that your insurance is more likely to pay you, the patient, for your chiropractic care that they would refuse to pay your chiropractor for. Why? Because you have the power. YOU pay them for a service and if you’re unhappy with your service you’re more likely to change insurance providers.

Chiropractors and medical doctors can only choose between in-network and out-of-network. At the end of the day, insurance companies WANT your business because it makes them money. Every time your insurance company does business with or pays an in-network chiropractor, it costs them money with essentially no return. Every time your insurance company reimburses or pays you, the customer, it costs them money, but they have to deal directly with the people paying them. As a result, it behooves your insurance company to pay you more than it does your chiropractor.

Your chiropractic has little direct effect on their profits so your insurance company has little incentive to treat them fairly. If they treat you unfairly with poor reimbursement and numerous uncovered treatment, there is a greater likelihood that you can stop paying them for services. In-network, the insurance company has a great deal of power, out-of-network, you and your chiropractor or medical doctor have the power to determine the best course of treatment without third party interference.

Why Corrective Chiropractic is Out-of-Network

Corrective Chiropractic CHOOSES to remain out-of-network. Not because we can’t get in because we don’t want to get in. As many of you already know, Corrective Chiropractic is not like a traditional chiropractic office. We do not simply treat symptoms. We treat the CAUSE of the symptom, often found to be a structural abnormality with your spine. Using specialized adjustments, therapeutic exercise and other modalities, Dr. Wickstrom and the Corrective Chiropractic team work together to bring your spine closer to its normal positioning. Correcting the cause of the symptoms that you’re having.

This fact means that sometimes an insurance company may not cover all of the services that the doctor may recommend. That doesn’t mean that you don’t need them, though. By using an out-of-network provider, you are able to receive a comprehensive care plan that is structured for CORRECTION of the CAUSE, not just the symptom care that insurance companies pay for.

Written by Angel Horne & Dr. Bret Wickstrom