Unless you have been hibernating like a bear you should be aware that nationwide we are experiencing significant issues with the delivery of health care in the good old USA. In Minnesota there are even deeper issues with the way the laws were changed to allow “vertical Integration” a “Minnesota nice” way of saying legal medical monopoly.
This is a factor as to why the largest health care insurer in the country that is based in Minnesota, United Health Care, only does business in 49 states. The only state it does not deliver its usual product in??? YOU GUESSED IT!! DING! DING!! Minnesota. They use Medica as their tool/product in this market.
Basically they (the plans and the state bought into the idea around 1984) that if one entity owned and controlled all of the aspects of care; Hospital, Clinics, staff, all associated therapies and such, even Pharmacy, they would be more efficient and would do a superior job of keep cost down and quality up.
How’s that been working for you?????
The problem now is the lack of competition. There are only four plans operating in the state and they have all focused on areas and segments of the market and have a cozy set up; kind of like organized crime bosses splitting up Chicago or New Jersey. Every ones gets a piece of the turf and they can put the squeeze on their market.
Prices get too high? Nooo problem, the state will make all of us (tax payers) kick in some extra tax coverage for the poor stiff’s they (insurance carriers) squeezed too hard already, the self employed. The insurance companies are making the self insured look like they cost them too much to cover and the insurance companies will not look good leaving them out in the cold. Let’s not even consider allowing more competition into the market, it could (I mean would) make the current plans look bad.
Sorry, but this is just my thirty-eight years of being in practice, running a clinic, attending meetings, going to the capital and talking to a lot of insiders in the health care system and getting a chance to look behind the “Health care Wizard of OZ” curtain.
So let’s take a look at the managed care handling of Chiropractic delivery since 1984. In that year we were told that to be a “good doctor” delivering appropriate services we had to keep our treatment numbers at or below 24 visits on average. This was a consistent value based on research and accepted standards. All reimbursement was basically “frozen” at that level in 1984 and for all practical purposed has only gone down (LESS) since then. Most Chiropractors are losing money on treatments – hard fact based on a study back around 2000.
As of 2016, regardless of the plan there is a “hidden cap” on the delivery of Chiropractic services state wide that is placed on the Chiropractor by the network they are in, not your insurance plan. This “cap” is now settling in at around 10 visits per person per year. SO, what happened to the 24 visits that were good back in 1984??? Good question!
The phenomenon is a takeoff on the Limbo dance. Basically, how low can the plans make the provider go before they fall down or quit, and now this applies to ALL health providers, not just Chiropractors, but that is another blog.
Your plan booklet may say “unlimited” or the ever great term ”usual and necessary” BUT you have to remember who gets to pick that answer and it isn’t you or the provider!! It seems that this initial fact is now a lost consideration in light of the average individual deductible settling in between $5000.00 to $7000.00. You will hit the provider limit long before you ever reach the deductible limit to get you plan to start paying on anything.
A key strategy is that all of us will have to change how we ask for and think of using health services. It is actually more effective and cheaper to practice more wellness and prevention approaches to care than waiting to get care or for the symptoms to drag on. You have to actually plan on spending some or the entire deductible amount but you may not spend it in the plan. Each of you will have to have to determine the value of getting care. Many plans now have deductibles in the $30 to $70 dollar range which is also in the range of most cash payments for an adjustment. The average fee for Physical Therapy is $150 per hour in this area. Our cost for seeing our CNP for family care ranges in the $80 to $130 and procedures all listed on our web site. In the same range as most walk in convince clinics. Chiropractic care can range from around $35 to $150 depending on the extent of your problems and the level of therapy or services needed.
So, how is health care like a box of cracker jacks? Well, from my experience I always expected the prize to be more and give me more satisfaction that what I ever got from the cracker jacks. I think most of us are expecting more from the expensive plans we all are paying for and the “prize” of coverage really never meets our needs or expectations. I think we all deserve than a health delivery system that can only deliver “yah never know what you may get in your health coverage”. I am willing to spend a buck on a box of Cracker Jacks to this lowering of expectations but none of us should be doing this with our lives and healthcare.
Chew on these thoughts while you are chewing on some cracker jacks!
Call Advacare clinics for a free consultation with our care coordinator to see how we can help you! 952-835-6653.
Clinic Administrator Advacare Clinics