My, how the times are a changin'.
Each year, insurance costs go up with higher premiums, higher deductibles and higher co-pays. With that, coverage seems to go down - with less visits available in each plan, more hoops to jump through, pre-authorizations and tighter regulations around medical necessity. Obama Care was meant to provide more accessible health care for everyone, and in some ways- it has... it has also caused increases in premiums and penalties toward choosing not to purchase coverage. Many families in our community can't afford care whether they have "the coverage" or not.
*Medical necessity is defined as accepted health care services and supplies provided by health care entities, appropriate to the evaluation and treatment of a disease, condition, illness or injury and consistent with the applicable standard of care. In evaluating medical necessity, the insurance company looks at severity of illness or injury through objective measures, how long the illness or injury has been present (acute vs. chronic) and if progress is being made under care within a time frame relevant to the severity of the condition. Chronic conditions, wellness and relaxation care is not considered medically necessary.
For years, we have watched these trends and started to wake up to this process - adapting as we could to create opportunities for families to continue with the care they have come to love and depend on. Often times, we would have to tread the line of integrity to get the insurance to cover the care provided. If a patient is coming in with systemic inflammation secondary to an auto-immune condition - we have to code for a musclulo-skeletal dysfunction or pain syndrome... the inflammation may be causing back pain - this is true. The major premise of Chiropractic care is to detect and correct vertebral subluxations - removing any interference to the central nervous system so that the innate ability to heal is activated and change can occur. Subluxation is only recognized by insurance in relation to traumatic injury - at which point they seek fault from your auto-insurance or assume there was a work injury, holding up the processing of a claim (they have up to 90 days to respond to us as the provider - in some cases delaying claims for 6 months or more). In chiropractic, we don't treat inflammation, auto-immune conditions or even low back pain - although... when the interference to the nervous system is removed, those things tend to respond and your body heals. Moving out of the insurance model allows us to provide the care that we do, with integrity - delivering care to you as a whole person - rather than treating a condition of a segment of your body.
With that - moving into 2017, we decided to hold the line and do something new and different. (well, new and different for us). This trend has been happening in medical practices for the past few years now. Releasing ties to the insurance companies and becoming a membership practice allows us to communicate, collaborate and coordinate care directly with the patient, based on their individual goals, needs and desires, in a simple and affordable way.
Similar to a Costco or Amazon prime membership - you pay an annual fee to receive discounts and incentives toward the products or services that you chose. Through March of 2017, the membership fee is waived for existing Pier View practice members. Being a part of a membership practice allows us to offer care plans to get from point A to point Z, inclusive of any and all services offered within the umbrella of Pier View in a customizable way for a simple monthly fee. We have multiple care plans for under $100 per month. Additional family members receive further discounts making continued lifestyle care affordable for the entire family. As a member, you can even receive discounts on a per visit basis - monthly plans are not required (though most families do choose this option).
Another benefit to this - you can still utilize your insurance benefits, HSA and bene cards, etc. What we have found over the past few years is that most plans have more inclusive coverage when they are dealing directly with their own client rather than through us, a third party. We provide a super bill either per visit or one time per month - whatever your preference. You simply address the envelope and drop it in the mail box. In most cases, you will receive remittance within 2 - 4 weeks.
If you have questions, we are happy to explain in greater detail how the Membership may serve you in relation to your goals and how benefits are coordinated based on your specific plan. Contact us to set up a no charge consultation.