EP91 Should You Take Insurance?

In this episode, we dive into one of the most frequently asked questions in the Chinese medicine community: Should you take insurance? While there’s no one-size-fits-all answer, I share my personal experience with insurance billing—both the pros and the cons—to help you make an informed decision. We discuss how insurance impacts your practice structure, financial considerations, reimbursement rates, and the unintended behavioral consequences that can arise. Whether you're already accepting insurance or considering it, this episode will help you weigh the trade-offs and align your decision with your values.

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Transcript

Unknown: 0:56

6321, Hey everyone, welcome back to the podcast. Better skills, better doctors. Thanks for joining me today. So today's episode is about a very popular question in the Chinese medicine field, and that is whether or not to take insurance. And I see it asked a lot on social media, and I asked, I get asked this by new grads or people who are about to graduate from school. So I decided to do an episode on this and share some of my thoughts on the subject. Now I'm not going to tell you whether you should take insurance or not. This is your decision, okay? And I just thought it might be helpful for me to share my own experience with taking insurance so that you can use it as you know, part of your research in making an informed decision. So I took insurance for almost the entire tenure of my practice. I actually got into it pretty early, around like, 2008 2009 when, you know, not very many insurance companies covered acupuncture. And I also, I took an insurance billing class a few times, and I did my own billing for many years. And, you know, eventually I did hire a biller. I did hire a biller when I got too busy to do my own billing within scheduled office hours. That was kind of when I knew when I was like, at home, at night, at billing insurance from home. I'm like, This is ridiculous. Okay, so that was my cue that I needed to hire someone to do my billing. Okay, so taking insurance, it's neither good or bad. Taking insurance is neutral. But if you do decide to take insurance, you have to understand that by doing so, you are now agreeing to play a game, so to speak, where the rules are set by someone else, and part of that agreement is that you now have to structure your practice and the way you practice around the rules of a third party and your decisions in your business now, most of your a lot of your decisions now, must be checked against this third party to ensure that you're not breaking any of their rules and even the decisions that have to do with non insurance patients. So this affects once you decide to start playing the game and you've entered into it, your whole practice is affected, okay, in one way or another. So I'm going to go through some pros and cons of taking insurance based of my own experience. Okay, so some of the pros, the obvious is that it gives you exposure, right? It's like free advertising. It's not like free as it is free advertising. Okay, so you know when you go in network with an insurance company, you now are listed on their panel of in network providers. And so when a patient who has insurance, of course, naturally, they're going to want to see a provider that's in their network. Ideally, or sometimes, they don't have a choice. They have to only see in network providers. So they go on their website and they look up for acupuncturists, and they'll pick someone, you know, there might be a whole list of different people, different providers, and they'll pick someone you know, usually based off of convenience, if their address is close to their work, or if it's close to their home, or something like that. You know, they may click on your website and do a little comparison shopping, just to see, you know, which practitioner they like, but this is how they're finding you initially, right? They're finding you through the insurance panel. So it is, it's like free advertising. And also, you know, outside of that, it just, you know, it brings more people in your door, which means now there's a lot a higher opportunity for you to do more internal marketing, so that can be referrals, word of mouth, things like that. I definitely got plenty of referrals from my insurance patients. They referred friends or family or colleagues to me who didn't have insurance. So you know, my insurance patients sometimes would refer cash paying patients to me, and that's just, you know, again, it gives you an opportunity to get people in the door. And now you can really use more of if you have a strong internal marketing system now you have them there. Another pro, it does create a lower. Financial barrier for patients, because most insurance companies, you'll either the patient's either paying a co pay or a co insurance somewhere, anywhere from like $10 to $30 sometimes I saw ones that were like $50 which was like, okay, but um, seemed a little high, but it was what it was. Or sometimes there's known like there's no CO payment, no coinsurance. And so it does create this lower financial barrier for patients to and more theoretically, more access to those who can't afford it otherwise, which is can be debatable, but still does provide a lower financial barrier, whether they need it or not. So those are some of the pros of taking insurance. Now some of the cons, in my experience, one of them being the pain. I'm calling this the payment at time of service dance, and this is so for those of you who don't take insurance, or about or thinking about taking insurance. So when you take insurance, whatever you are billing the insurance company that is now your your standard rate. And a strategy that many people use to ensure that they receive as much reimbursement as possible is they raise their standard rate. So and this is because an insurance company will not reimburse you for more than what you would normally charge a non insurance patient. So let's say, for example, for and with easy math and numbers, let's say you normally charge$100 for a treatment your patient's insurance Max reimbursement is 120 now you cannot bill the insurance company $120 because that is above what you would normally charge. So a strategy that people will use is they raise their standard fee to and I'm going to use this for this example. So raise the standard fee now from 100 to$200 a treatment, so that when they build the insurance company$200 they will be reimbursed the max amount of 120 because what they build is higher than what the companies the insurance companies Max is, if you know you charge, if they build the insurance company, $100 then they'll just get paid $100 they won't get paid 120 because they will not they won't pay out more than what you Bill, right? But for your non insurance patients, in this example, let's say that you don't want to charge them $200 or treatment for whatever reason, right? So you give them a time of service discount, which means patients who are paying out of pocket can receive a time of service discount if they pay at the time of service, meaning they pay on the same day that they get treated, which is typically what most people do, right? If you're paying, you know, charging people per treatment like that now, and the time of service discount in this example is $100 so the patient gets a $100 discount on the $200 service the insurance company does not get does not qualify for this time of service discount because they do not pay at the time of service. They distribute payment at a later date. So now there's this dance of semantics at play here that is perfectly acceptable, but it just adds this extra layer of consideration and explanation that is necessary if you want to get paid what you want or get paid as close as possible to what you want. Another con of insurance is that it doesn't cover every diagnosis. Each insurance company has their own list of diagnosis codes that they will cover for acupuncture. So it's not like you can take a patient and they have whatever condition that they have or whatever problem or complaint that they have, and that every insurance company is going to cover that usually they have. Very often, it's pretty limited to pain, different types of pain codes. And you know, again, it depends on the insurance company. Some pay for more stuff than others, but pain is usually something that most insurance companies will pay for. The other con that is probably the biggest complaint amongst people who are billing insurance is the low reimbursement. Some of the reimbursement out there, it can be pretty all right, but a lot of the reimbursement can be pretty bad, you know, I see on, you know, social media groups people complaining about reimbursement as low. Was like$20 or, you know, $30 and that's like per treatment, and that's just unsustainable. And in the thing is, Another con is that reimbursement, it can change at any time. So you know, your insurance company can decide the next year that they're put out their new fee schedule, and it's going to be lower, and you as a provider have no negotiating power over this. Another con is the slow reimbursement, so the time it takes to be in reimbursed, and so insurance companies, most insurance companies, are required to pay out by 30 days. Okay, so you could be waiting. You're usually waiting about a month before you get paid for for a patient, for a claim, and another con, is the time it takes to submit claims and to follow up on unpaid or denied claims, if you don't, and if you decide to not do it yourself and hire a biller, then you're paying that bill or either a cut or a percentage of your reimbursement. So if that reimbursement is really low to begin with, now you're already you're taking more off the top in order to pay your biller. Okay, another one is your SOAP Notes must now be in a format that you were that if you were to be audited, or if the insurance company asked for your treatment notes, it will. It now shows, it has to be formatted in such a way that shows the timestamps of when the needles were inserted and reinserted. Okay? Basically someone is always watching, right? Maybe not literally every day watching, but more or less someone is always watching because an insurance company has the right to request notes at any time and and that's just how it is right to make sure. I know also that a lot of insurance companies, they do, hire people who are either acupuncturists to to review charts, to review people's notes, to make sure that they're billing diagnosis codes that make sense and number of needle insertions that make sense. So now, some of the what I'm calling unintended behavioral consequences that I've noticed have arisen from people who are taking insurance. These are kind of a mishmash of ones that I've experienced myself and ones that I am, I'm kind of seeing out there in the Chinese medicine world of people who are billing insurance. So some unintended behavioral consequences are there's now like a temptation to bill more codes to increase reimbursement, especially if reimbursement is low. So kind of padding it a bit to increase the reimbursement, and finding ways to, you know, beat the system, whatever that means for some people, but finding ways to beat the system to increase reimbursement. And unfortunately, you know, some people will adopt some dishonest practices and then justify them because the system is broken, or they think the insurance company is low balling them and that they deserve more, which is, you know what? It's true, you do deserve more, but again, this is the game that you have agreed to play, and overall, kind of a stretching of the truth to make a diagnosis code fit. I see this a lot on social media groups like for example, if you have a patient that has a painful skin condition on their scalp, then it is being billed as a headache because there is an ache on the head. That is quite a stretch. And if this person was ever audited it, they probably would not fly so. And now another unintended consequence of this, of just kind of insurance covering acupuncture in general, is that it commoditizes acupuncture, because in the insurance world, acupuncture is identified by insurance companies using procedure codes, and each code has been assigned a fee schedule, and the value of acupuncture now lies in the price per code instead of the outcome or the result of the treatment, which means you can be a 30 year seasoned practitioner with highly specialized training, or you can have a first year general practitioner, and they both get paid the same so. Okay, and in the end, actually, the more seasoned practitioner may actually get paid less overall per patient because their skill level is so good that they graduate the patient in fewer treatments than the new practitioner. So, you know, think about that. That's interesting. Now, a few kind of mindset, things here that I want to talk about related to billing insurance. You know, many of you take insurance, but you hate insurance companies, and you hate the system, and you hate the inefficiencies of insurance companies that end up creating more work for you, right? If you truly feel this way and feel that insurance companies are the devil, or you have major ethical issues with the insurance system, but you're still engaging with it in this way, it means that you are operating every single day of your life opposite to your values. You know living in incongruence or unaligned is what will overwhelm you and eventually burn you out. You know living every day on a un authentically is damaging to your mental and your physical health. So in order to prevent that from happening, you have two choices. One is to stop taking insurance. Now, if you're not willing to do that, then your only other option is to change your attitude, in your mindset around taking insurance, because trying to have it both ways, meaning hating it while accepting it as a revenue stream, is going to make your life miserable, and it's probably already starting to. Now, many of you want to drop insurance, but you're afraid to do it. And some of the reasons why you're afraid is you think you'll never make it right. If you, you know, if you, if you stop taking insurance, then all your patients are going to dry up and you're just going to close you're never going to make it okay. Now, one of the main reasons, if not the main reason why people take insurance, even though they don't want to, is because they don't want to market themselves, or they think they don't know how to market themselves. And I get it. I totally get it. If you're never had to actively advertise or market yourself, it will seem foreign and it will seem scary, but marketing and advertising is 100% a learnable skill, and it that takes courage to implement. So you just have to decide if the discomfort that you're feeling now taking insurance and accepting low reimbursement and all the other things that aren't working for you as a result, you have to decide. You have to decide whether you'd rather stay in the discomfort that you are in now or be in the discomfort of learning this new skill and trying new things and taking this leap. Okay, another reason that people are afraid to drop insurance is that they're afraid to disappoint their patients. You know, if they drop a patient's a long time patient who's been coming, and they decide to not take their insurance anymore, they're afraid that they're going to disappoint them, they're going to disappoint their patients. And I get that, but this is an example of people pleasing. And if you've listened to me before, if you've worked with me before, you know that people pleasing is lying when you think or want one thing, but your actions are expressing something else that is the definition of being a liar. And living your life every day as a liar is exhausting, and it catches up with you one way or another. Okay, now if you do decide to take insurance please, please, please, take an insurance billing course so that you know how to bill properly, and so that you actually know how the insurance system works, at least in the context of your practice. And two that I can recommend. One is American acupuncture Council and the other is Maury West. Those are two. Those are both very good insurance billing courses. So take them both. Okay, in my mind, you can't take too much so, because I see too many people out there who are billing insurance and who are asking questions on social media that they really should know the answer to before they started billing on behalf of their patients and getting a network when it comes to insurance billing, being ignorant on how it works and the proper way to Bill can create a lot of hassle for you down the line and possibly create some serious trouble for you. Now, a lot of you may be saying, or have said, well, you know, I'll just hire a biller, right? Like, I don't need to learn how to do this. I'll just hire a biller. Okay, you can hire a biller, but you you still need to understand how all of this works, because you need to know how to explain to your patients when they ask you, when they ask you, because they will why they. Why their claim was denied, what's up with their CO payments? How does their co insurance work? All these things. You have to know how to answer these, because they will be asked, and your biller is not responsible for helping you understand this. They are not there to teach you about insurance billing. Their job is to operate with the assumption that you already know that what you need to know, and they're just helping you take a load off your plate by freeing up some time that you would otherwise spend submitting and tracking claims. And if you take insurance, it's a revenue source for your business, right? So you can't just stick your head in the sand on this if something isn't get getting paid out correctly, if money is missing or if your biller is dropping the ball, you need to be able to recognize it as soon as possible. Taking insurance, it is not a passive event. You must be involved and vigilant and knowledgeable through it all. So I could keep going with this topic, but this is getting to be a long episode, and I'm probably going to listen back to listen back to this after it's published and realize that I left something out, but I think I shared most of my thoughts on this topic. So hopefully this was helpful insight for you and and that's all I have for today. If you need help with getting unstuck, getting out of your own way, or feeling dissatisfied in any way in your life or your business, then life and performance coaching may be exactly what you need. Head over to TCM hub.com/living, practice, or click living practice at the top of the page. There, you can read more about coaching for self employed Chinese medicine physicians and schedule an introductory chat with me. If you found this episode valuable, please share it with a friend, and if you could be so kind as to take a moment to leave a written review in your apple podcast app, or rate us on Spotify, we would really appreciate it. Thanks for listening and for considering new perspectives. Talk to you next time bye. You.