Insurance and Our Office
Dormont Chiropractic has always been and will always be an Independent office. There are a number of reasons why we have chosen to remain outside any of the networked insurance plans, HMO's and PPO's.
Our Patients are not exclusive to only one Insurance Company
We cannot afford to belong to ALL of the Insurance Plans that are out there. If we were to become a member of Blue Cross/ Blue Shield for example - only 10% of our currently active patients are members of a BC/BS plan. What about the other 90%? 5% of our patients are enrolled in UPMC – if we were to enroll in that program we would alienate about 95% of our current patients. 7% of our patients are Medicare recipients with various secondary Medigap insurances (AARP, Bankers Life, etc.). Other patients belong to US Healthcare, Aetna , Heath Assurance... the list goes on and on. It seems unfair to segregate our patient base in such a way. How do we choose which Insurance Programs we will be members of and which we won't? And what about the large percentage of our patients who do not have any insurance or whose insurance does not cover chiropractic care?
Budget and time constraints
In order to be a provider member of an insurance program each insurance company has separate requirements that the providers must meet. Some require extensive malpractice coverage – coverage that is above and beyond the usual needs of a doctor of chiropractic – which would become more money in overhead costs that we would have to pass on to our patients. Others require you to take continuing education classes that they have chosen - classes that do not apply to the continuing education credits that are required of chiropractors for chiropractic licensure- costing our office hundreds of dollars more a year per insurance program we belonged to and requiring the doctor to be away from the office more in order to attend these classes. Some require that you accept a much lower fee than that which is usual and customary for your profession creating the need to set patients up on treatment plans (ex: 3 times a week for months at a time) in order to recover expenses. Others only allow for a small number of visits per year and require a mountain of paperwork for those visits. We would also be dependent on their determination of payment – not only in amount of payment but in timeliness as well. How do we pay our office costs when the insurance company is late with or holding up on payment for services? We are not a large office with many doctors and therapists, so if Dr. Vaughan doesn't get paid – no money is coming in to the office – period. And many require the submission of much more paperwork than would seem reasonable causing the need for us to hire more office personnel and therefore the need to pass that added expense on to you, our patients.
Unnecessary involvement of gatekeepers
And most importantly many Insurance Programs require that you obtain a physician referral before seeking specialist care. We feel that diagnosing chiropractic needs is a specialty only a chiropractor can accomplish. Physicians are not trained in any way to diagnose what can and cannot be treated and relieved through chiropractic. Furthermore, although some physicians are slowly becoming more accepting of what the medical profession refers to as “alternative” healthcare, most physicians still refuse to refer their patients to chiropractors.
We have found that in order to maintain the type of practice our patients appreciate (no lengthy scheduled care, no unnecessary x-rays, a set fee for visits, walk in availability, etc…), keep the costs of our care well within the low to average usual and customary charges for care in Western PA, and treat all of our patients equally regardless of insurance coverage, we must remain an independent office.