The Pitfalls of Filing Insurance

The other day Jiang Li, our very popular Chinese doctor, inquired about joining an insurance network. She wanted to know if I belonged to any and what I thought about being a provider. I thought it might be an interesting topic to share with the general public.

Now, I'm not sure about how it is with acupuncture, but I can tell how it is for me. The one advantage I can think of is the possibility of increased exposure to policy holders. As I thought more about it, I found quite a few disadvantages.

One problem is that the insurance companies beat you up so bad. Allow me to explain. If you are an out of network provider, the deductible and co pays are significantly higher for clients than if you were “in network”. This effectively inhibits seeing the out of network provider. If, as a practitioner, you are “in network” you must agree to whatever terms the insurance company sets. Part of the agreement with the insurance company is that they're setting the “allowable” fee which, by the way, can be about 50% of the normal fee. The difference can not be charged to the policy holder, so the doctor eats it. In addition the time involved in verification, processing and follow up significantly raises a doctor's employee overhead. In our office, Mindy was spending so much time within that arena that it took time and energy away from taking care of the clients. (And me. :-))

The increased overhead is easier to absorb if your practice lies more in the therapeutic realm because you can add and bill for a number of other modalities each visit, including heat, ice, muscle stimulation, and therapeutic exercises. For the consumer that can mean a 30% co-pay on one hundred plus dollars instead of forty which will bring the co-pay up to and past the original forty dollar office visit.

Last but certainly not least is the simple fact that “health” insurance (it would more accurately be called disease insurance) does not pay for wellness care. Yes, I'm aware that some policies will pay for “alternative therapies." However, there must be a diagnosis and treatment of symptoms which automatically falls outside the realm of wellness. The real problem is the effect this has on the mindset of the practitioner and client.

If we are to render a diagnosis then we first have to make a judgment about a particular symptom. Once we judge the symptom as bad we must find a way to remove it. This is what they call the medical or treatment model, which has absolutely nothing to do with wellness. In fact, if a symptom has manifested to alert a person to the need for change, then treating the symptom would be the antithesis of wellness. That doesn't mean that it isn't ok to have symptoms treated at times. It's just impossible to do both. You've probably heard the saying, “you can't serve two masters." Well, trying to be in the treatment model and the wellness model simultaneously would be doing just that.

Over the last twelve years of practice I have noticed something very interesting. In general, clients who had insurance pay for their care did not get as good results as clients who didn't. I believe this to be due to fact that it perpetuates the idea that we are being fixed by the doctor instead of taking control and responsibility for our own healing process. In wellness the practitioner becomes the facilitator, not the fixer.

Working in the insurance game, and in the treatment model, undermines the fundamental understanding of wellness and it quite simply comes down to this: It's a game I can't win.

Our Physical and Mental Flexibility

Recently a friend told me that his upcoming engagement had been called off. Understandably, he was feeling pretty down about the unfolding events. They were unable to meet on one particular issue which became the demise of the nuptials. In sharing this with me he said something that caught my attention and prompted this article. It went something like this; Yada, yada, yada, “that's just who I am.”

That was a pretty significant statement, and one which I'm sure most us have made at one time or another. Once we state who we are, then we have effectively absolved ourselves from considering any change or adaptation. Throughout our lives we develop patterns which protect us from the idea that life didn't go exactly according to our plan, which makes us inflexible to any other experience. I thought to myself, is it who we are or who we choose to be that defines us? It reminded me of a Billy Joel song called the “Angry Young Man.” I think the lyrics do a great job of explaining this phenomenon, so I included a few verses.

There's a place in the world for the angry young man
With his working class ties and his radical plans
He refuses to bend, he refuses to crawl
and he's always at home with his back to the wall.
He's proud of the scars and the battles he's lost
He struggles and bleeds as he hangs on the cross
And he likes to be known as the angry young man.

Give a moment or two to the angry young man
With his foot in his mouth and his heart in his hand
He's been stabbed in the back, he's been misunderstood
It's a comfort to know his intentions are good
He sits in a room with a lock on the door
with his maps and his medals laid out of the floor
And he likes to be known as the angry young man.

And there's always a place for the angry young man
With his fist in the air and his head in the sand
He's never been able to learn from mistakes
He can't understand why his heart always breaks
His honor is pure, and his courage as well
he's fair and he's true, and he's boring as hell
And he'll go to his grave as an angry old man.

It is never about what happens; rather it is about our story about what happens that determines our response. There is also a direct relationship between the degree of flexibility in our structure (body) and the flexibility of our response. As far as my friend goes, who knows whether or not they were meant to be? I do know this: the body never lies and in this case the inflexibility I could feel in his spine was very apparent. My goal with each member of my practice is to help them gain a greater flexibility in their structure, so that they may more effectively adapt to the inevitable challenges and changes that come their way.