Prepay Plans. Are They A Barrier to Care?

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Hey, good day everyone. Thank you for being with us. Thank you, ChiroSecure for always putting this on. Realize ChiroSecure HJ Ross, myself, we have a very vested interest in you because you are the future and the lifeblood of the profession. And if you’re not doing well, neither are we. It’s important for us to make sure your practice always thrives. So whether you’re coming to a seminar with me, you’re a member of the network, or just tuning into these shows with ChiroSecure, Our job is to make sure we can do things that can help boost your practice, get you to have a little bit better understanding. And being that I’m a coding and billing expert, I always try to slant towards that. What we wanna focus on today is about patience as always, but let’s talk about patience in this way. Let’s talk the money and how do we do it? What can we do when it comes to. Pre-pay chiropractic plans. Let’s go to the slides. What do we mean when we talk about pre-pay chiropractic plans? This is for the most part, someone paying for the services before they get them. This means really no insurance involved, anything like that. But are there things here that could be a positive force? And what I want you to think of is if you’re not adapting, if you’re not making some changes on a regular, You’re beginning to die on the vine. One of the things my dad always taught me, my dad was a chiropractor as well, was this is a chiropractic practice, not a perfect, we’re always learning and updating. So let’s update ourselves a little bit today on what’s going on and what can we do with prepay chiropractic plans. I think always we have to think first of. Why do people think of not going to the chiropractor? What is it that you know? And I’ll say, this is the fast money family feud. Why do they wanna not go to a chiropractor? You know what things will prompt them for that, in that sense? Sometimes people will say they’re not real doctors. I experienced this as a kid. Where people would say, your father’s not a doctor, things of that nature. That’s changed quite a bit, hasn’t it? Where we are in society, what they’re thinking of, whether it’s Medicare, va, health insurance. We are ingrained and in fact become a darling of many things, particularly because the opioid crisis. But that’s part of it. You know how some people think they still have a little old school? How about this though? Someone thinks it’s not gonna work for me. What can chiropractic do for me? Is it really gonna be helpful? I don’t even know. Or, Maybe it’s just gonna make me worse, or maybe it’s gonna hurt me. So we’ve gotta deal with those type of barriers. Another barrier, and I’m sure you’ve probably maybe seen this show if you haven’t quite popular, but why not chiropractic? You know what, there’s something called condole phobias. What is that? That is the fears of bone cracking. In fact, if you’ve ever watched this show, which I’ve honestly seen and say, it’s a fairly positive show, I like it. They obviously enhance the sound, the cracking, the popping. And of course for some people that think that’s fun, but others are thinking, oh my God, what’s happening? So there’s a good and bad side to that. So getting people to think I gave a good adjustment because there was no audible. Was it not good? But again, the sound people are fearful. If you’ve seen the show, you know what I’m talking about. What about hey, they have insurance. What about that? Sometimes they don’t come in because there’s no, or just limited chiropractic benefits. We’ve all seen policies like that, or the benefits are so ridiculously poor, we don’t wanna even take it or use it. How about plans that people go I have insurance, but the deductible is literally $5,000. When I see that, that’s a cash patient. My goodness. I think a thousand dollars deductible for most patients, unless they’ve been to something else, is probably a cash patient. And then what about people with no insurance? This is where I think chiropractic has always been this bridge. I’ve been around this my entire life, of course. And I’ve seen chiropractic always be that bridge of health healthcare that many times people otherwise don’t have access to. Because if you think of it, what is the real barrier to care? Why not chiropractic or any healthcare? It’s this, and there’s actually a diagnosis code for it. Z 91, 1 90. That’s actually an ICD 10 code new for this year. It says patients noncompliance with other medical treatment and regimen due to financial hardship. How many of us know someone? Let’s be honest that we know that’s not going to the doctor for something they need because we don’t have the money. They can’t afford it. You can put me on that list. I have friends, I have acquaintances. I think we’ve all been there. We have patients. So what does chiropractic do or where do we fit? And this is what I want to hit on, where prepaid plans may help you. Studies of the NIH show insurance coverage for acupuncture, chiropractic massage is just simply not as good. We know that. Is it better than it ever was? Sure. In many ways. But at the same token, there are still limitations. But because of that, take a look at this data. The data suggests that Americans are more willing to pay out of pocket for a chiropractic or massage when it’s not covered by health insurance. In other words, I think we have built in our profession a way of people understanding. Don’t depend on insurance. How many doctors out there right now don’t take any insurance at all? That can work. Certainly, I would say I’m gonna cherry pick. I’m gonna pick some good ones. But if it’s not a good one, no, we’ll do cash. So what can you do? How do we make this work? If they’re willing to pay out of pocket, what will they pay? How much is it? What’s the barrier there about money? So I think many of us think I’ve gotta make it cheaper. Here’s one thing I’ve learned, is cheap always good? I don’t know. Have you ever picked a doctor because it was cheap. No, you’re obviously looking for someone reasonable, but certainly is there anything wrong with saying I’m gonna give someone a discount, I’m gonna give ’em a little discount. Okay here’s a problem for discounts. Can we legally give a discount if we’re also billing health insurance? And there is where the dilemma lies. Generally, you may not have a fee that is higher for insurance than for people. You normally bill for cash. So therefore the answer is actually no. This is why you can’t give big discounts. Cause I was gonna say, if, why is the insurance having being charged 300 and a cash patient’s being charged 50? Certainly there’s some issue there with when you have to bill insurance, does it take a little bit of time and effort? Sure. So the department of the Office of Inspector General, excuse me, and it’s specifically opinion 0 8 0 3, they have what they call a time of service discount. So this is something I think a lot of offices do when someone comes in, if they’re just paying cash. You give them off 5% or 10%, maybe as much as 15. That’s actually within legal bounds. Under federal rules, what you’re doing is passing along kind of the bookkeeping savings Hey, I’m not having to bill insurance, therefore, I’ve taken a little bit off. Now here’s the problem. It can’t be any more than that. Why? If you’re giving ’em off bookkeeping, can you tell me reasonably. It’s double the amount of work and cost to bill insurance, then it’s not. Now, I know in some instances we may say that, but for the most part, no it isn’t. So what you’re doing is passing along the administrative costs. I kinda like that. I think that’s reasonable. But let’s face it. Have any of you ever been in a store and gotten excited when, oh, 10% off? Do you go? My God, I better stock up. No. That’s not really a lot. In fact, I almost think that’s just a goodwill gesture. I don’t think it makes much of a difference. Now, one quick note for those that are from California, there is the exception for California under business and Professions code 6 57. California is the one state that does allow you to have a completely separate price for cash. No insurance patients than you would for insurance. That’s not true in any other state, so be careful. This is why whenever you speak to someone you wanna make sure, do they understand my state, my area. When we do seminars, that’s what we do. So if you come to an HJ Ross seminar, trust me, we’re gonna deal with your state and your issues. With that being said, I want to talk about chiropractic as a business, and I want you to think in these terms, businesses over time have to adapt. I want everyone to think of. Sears here. Now, for those of you who are in my age range, Sears was the monolith of retail. Initially it started as a catalog company. You ship things out or ordered it, but then because of people moving into the cities, they built big stores. Why didn’t someone at Sears kinda look around in the early nineties going, Hey, wait a minute, this Amazon company, Is beginning to sell things that we sell and just shipping it. Why don’t we go back to that? Think of the infrastructure for Sears was already there. They had giant warehouses. They already had a catalog. Couldn’t they get someone to digitize it? They didn’t. And so what happened? Sears was closed. So I want you to think of how stores adapt. Here’s an interesting one. Think of the store target. We’re a business. Think of tar Target’s. An interesting story. You go to Target, you can buy a lot of different things there. But if you go into Target, the first thing that I’ve noticed when I’ve been in recently when you first walk in, there’s two to three aisles of 99 cents. Store items, cheaper dollar. And that’s to satisfy cuz people like the 99 cents store, there’s a certain fund to the Dollar General style. It’s not always the highest quality good, but hey, I can buy 10 of ’em for it’s $10. And so there’s a certain sense that they realize we wanna adopt that to allow. Patients that are looking for that to get it. So I want you to think of what is one of the biggest growth areas for chiropractic that’s been over the last few years? The style of care that’s offered by a place called the Joint, which is very similar to Massage Envy or what’s that? Modern acupuncture one. And what do these do? They offer prepay. So I’m thinking, shouldn’t we kinda look and go, Hey, wait a minute. Why are we letting them do that model? If it’s working, why aren’t we offering it? Or can we offer it? So let’s talk about that. Cause I think it would be a smart idea to say, Hey, when someone comes in, they have several ways to pay. Hey, if you have good insurance, we’ll accept it if you have an auto injury, PIP or otherwise, sure. But if you have a really poor paying insurance, oh, I’m sorry, I don’t accept insurance and here’s what I have for my cash price for your single visit. But what we also offer is something else where a person can prepay a series of visits. And by prepaying a series of visits. Here’s what in, it’s interesting because it’s not billing to insurance in the same way. Now you can offer a big difference. Cause notice when you go to the joint, if you get one visit, it’s honestly expensive. They discourage that. But when you buy multiple visits, you know you buy two per month or 24 per year, or 36, whatever the number, the fee gets lower. So I’m thinking. Why maybe wouldn’t we try that now, is that gonna be for every patient? But think of, give them an opportunity? One of the things my dad did was not really a prepay, but he let people pay. When a debit card started getting big, he said, Hey, what we’ll do is we’ll just debit your account every month on the 15th, whatever payday, to allow them to come in. And that way they could come in for multiple visits, not have to pay it all at one time. And we have patients that finished with care, we’d hit their account for another six months. It worked because it made it affordable. Think of it. Would you, many of you have purchased the car you have. If you had to pay for all of it at one time, probably not. So I think this is something you may wanna start to think of. Why don’t I adopt something like the joint model in your office? Now, there’s some rules you have to do that. I’m gonna say for all of you in every state, this is something you pretty much can do following certain parameters. And this is what’s important. And what I emphasize to you here is do it in a way that you’re doing it within legal bounds. And it’s fair to everyone. So here’s how it works. In order for this to be done, it, number one has to be what we’ll say is a fee for service. One thing you cannot do with the prepay is say, Hey, here’s a membership for a thousand dollars, and you can come as much as you want for six months. That we cannot do. We’re not memberships, we’re professionals. So you can’t sell them unlimited visits or just visits for time. That’s like insurance. So what it has to be is a fee for service. So what you can say is, Hey, normally our visits are $90 a visit. However, if you buy a package, we will sell you 10 of those visits for $500. So instead of having to pay, close to a thousand, or more than a thousand, we’re gonna offer it to you. For only 50 a visit, but you have to buy it all at once and paid up front. I like that. I think part of it, of what I find is that people that have done these patients seem to be committed. They know they have it, they’re gonna come in for it because if they come in and pay cash, After two visits, they feel pretty good, not great, they’re out of the acute pain, they might say, eh, I don’t need it. It’s not so bad. But now they’ve made a commitment. So is it for everyone? No, but I think there’s a way here for you to offer this cuz there’s definitely gonna be some people, I have offices that do these almost exclusively. I have one, and this, I’m not kidding you when I say this. She has a practice where her most expensive package is close to 6,000. Now, in my opinion, I think that’s a little high. I wouldn’t recommend that. In some states she can’t even do it, but she does. But she admittedly says, she goes, oh, Sam, I don’t sell that many of those $6,000 packages. Her typical packages are 800 to $1,500. But she says this to me though, and I speak to her a few times a year. She goes, yeah, I only sell two or three a month. Wow, I like that. So why not? So here’s what you have to do. It has to be a package, meaning a set number of visits or services, tangible service for service. Service for fee. There must be a refund policy for the unused, this is important. You can’t say for a thousand dollars come as much as you want. And then they don’t ever come. And then you say you can’t get your money back cause you never came for a thousand. They can come 10 times or 20 times that way. If they bought 10 and they only use half, they get half of their money back. The other thing I would recommend is don’t put an expiration date. Some states actually will make you do that, but I would say generically you want to encourage the patient to come in. No question. You wanna plan for them, but if they miss it, I don’t wanna say it’s gonna expire next month, because if it expires and they haven’t used all the visits, you do have to refund them. But here’s what I like. Will there be some patients that would be open to this? That might be something they’ll find. Hey, that’s of value to me. I think there’s a place for it, but there’s some things you have to do and understand for different states. And I’m just gonna give a few as an example, and I’m gonna implore you, please know your state’s rules, but I’ll give you an idea that overall I think if you fall within your sin here, you should be safe in the state of Texas, their joint model, let’s say you can do it however, the patient has to be fully informed of everything there. In other words, it’s a small contract that says, here’s what you have purchased. Here’s why. Here’s the plan of care. That way the patient fully understands it, in other words, and they want a 12 point font as well. But the bottom line is that it’s for a limited amount of services over a number of visits, if you will. And so long as that’s written out, it’s fine for the patient with an expiration date. And if the expiration happens, the patient gets refunded or has to redo it. What they’re doing here is protecting the consumer. It’s a no surprise that, hey, if I bought 10. And I don’t use them. You can’t say you, they don’t come back. No, I if I don’t want them. You have to refund the money. And that’s all they’re doing here. In the state of Florida though, it’s even a little bit different. They’re going to allow it. But the state of Florida says if it’s over $500, you have to put the money into a separate account into basically an escrow account. That way as the patient comes in, you draw it out. In other words, they’re protecting that. If something happens, the patient’s money’s there. What if something happens to you and they need a refund, but you’re not there? But they also make that it can’t be more than 1500. So the one place I mentioned, oh, like they’re doing 6,000 is clearly not Florida. But you know what I like here? Hey, is this something a patient might be akin to? What if you could do 10 of these a month for people who are committed to care? They’re thinking, I know I need to come in. Think of a functional medicine practice. I think this works well. Montana also requires an escrow account, so that’s the one thing I would check to see. Does your state require that? Most don’t, but I’m gonna say before you decide, know what your state requirements are in Georgia, they even go a little bit further to say it’s considered unprofessional to enter in a financial contract, except when the patient understands what the contract amount or contract is about. Notice here not less than 12 point font. An initial line must be the next for the refund policy. That there is insufficient ev and they even tell you, you gotta put in here insufficient evidence that receiving chiropractic care will lead to death. Disability. The said statement must be typed in not at least 12.5. If you think about it, isn’t that something we already have to do in our informed consent anyway? You know what? This is the same thing, giving a patient a chance to understand what they’re buying. In that way, if they feel remorse don’t want it, they can. There’s a 48 hour, Hey, I wanna drop out. And again, if the care is not later given, simply refund it. I like this idea. Is it gonna be for every patient? No. But are there gonna be some? And so this is another arm that when someone comes in and goes, Ooh, I won’t be able to come that many visits. Let’s get them set up on this type of plan. The basic rules of prepaid compliance simply comes down to doing this consist of a specific number of visits over a stated period of time. Always put the terms of your plan in writing and you cannot offer unlimited. It’s gotta be this what you bought. Now, I know some of you say what about if they buy 10, they get two free. If someone buys 10 and they get two free, they’ve bought 12. So those aren’t free. So you gotta be careful and then you’d have contingencies for them that what if during the period of time the patient comes in and now they’ve been in an auto accident? Potentially because the treatment with this might be a little more limited with an auto accident may change because the amount of services. So if that’s part of your contingency, it should be written out. I would suggest make sure you outline an appointment schedule for them. Try to get them committed. Don’t just leave it open ended. I would show that there’s a recall system that patient, Hey, what’s going on? You missed the appointment and you’re not allowed to discount services based on you’re doing it because of reduced administrative costs, but really just the rule. Bottom line, what I’ll say is have a refund clause. Whenever I’ve run into problems, and this is something as a coding and billing expert, I do a lot of expert testimony and other things, and the one thing I’ve ever seen when this becomes a problem is when doctors wanna fight patients over the money. If a patient doesn’t get the care, they don’t wanna come in, don’t fight them for whatever reasons they’re leaving, say, I’m sorry that you know you’re leaving. I’ll see you next time. Here’s a refund of your unused portion. Don’t make it a big deal. So for refunds, By example, if their, if your normal visit is 80, but now they can buy a package where they get ’em at 50 each because they get 20 visits for a thousand. That means if they use only 10 of the visits and they’ve paid a thousand and they bought 20, they get half of their money back. Don’t try to prorate it like no, it’s gonna go back to the regular rate. If they bought it at 50 a visit, that’s the refund. Keep it simple. Don’t fight them over. Just calculated off of the visit charge that they’ve paid, not your regular visit. Even if the doctor claims there was extra services, don’t get involved. Realize the Board of chiropractic is gonna side more with the patient unless you make clear. All the parameters. And bottom line is what if you don’t wanna see the patient anymore? What if they become unruly or otherwise? Goodness, you can say, we no longer will continue, but here’s a refund of your unused services. Here’s the way I look at it. The barrier to care often is money. Chiropractic has done a very good job, I think, of making care affordable. Or accessible. This could be a tool to make it more accessible by taking away the larger cost, which means you can still have your $80 insurance price, but because it’s a package and insurances don’t buy packages, we don’t bill them there, it is why it’s different. A single fee for service, whole nother issue. So I would say this may be something to think of and start to say, Hey, could I make this work? Start on a small scale, see how it goes. But I’ll tell you what, a lot of offices do this and have done very well Why wouldn’t you adopt this? Remember, don’t be blockbuster. Blockbuster had the opportunity to buy Netflix, I think for 10 million. Some ridiculous amount. They said, oh no. People are gonna go to the video store. Oh, really? Not so much anymore. So understand, there’s always an adaptation process. We go through charging any more than is quoted. Be careful. Just keep it straightforward and simple at HJ Ross. And if you’re a network member, that’s what we do. Get me to be part of your team. Once you join, you can call, you can email. We can even zoom on all types of topics. We’re there to help you get paid more, to make sure you’re doing it right, compliant, but ultimately keep your practice successful. Until next time, friends, take care.