The problem with medical insurance

My wife and I pay about $1200 a month for our personal medical insurance.

That’s a hefty chunk of change and yet by no means an expensive plan comparatively speaking, but since we pay for insurance, that means everything we need is covered, right?

No.

Oh, well we can at least choose the best provider in Portland for specialty care, though… Right?

Yeah… also a no. That insurance plan only allows you to see providers “in-network”.

Hmm.. Well, I need this procedure done and found a provider “in-network” who thinks it should fix my problem and wants to do it. So my insurance will let me do it and cover all of it, right?

Oh boy. No. No. Noooo.

I mean, it’s possible, but not guaranteed. They might approve it and pay for some of it and you may be paying the cost of the rest. It depends on a lot of things completely outside of you and your doctor’s control:

1) If the AI insurance software that sorts your claim finds the right combination of words and phrases that it likes, it MAYBE will approve your claim.

2) If it gets denied by the AI filter, then the random 3rd party insurance adjuster (NOT A MEDICAL PROVIDER) assigned to your case MAYBE will decide that there is sufficient enough documentation that you need this procedure and push it through OR deny it because they think (despite their lack of medical education) that it doesn’t meet the standard to be approved.

3) If that random 3rd party insurance adjuster (NOT A MEDICAL PROVIDER) decides you need the procedure, then they decide how much they are willing to pay for your procedure.

4) If insurance agrees to pay a portion for that procedure, your “in-network” doctor is then forced to accept whatever price the insurance company offers. This leaves them to decide to either pass the remaining cost of the procedure off to you (the patient) or eat that cost.

FUN FACT: The amount insurance actually pays your doctor will be a lot less than what your doctor needs to charges for that procedure because seeing you (the patient) for that procedure, costs that doctor X amount of dollars in materials, employee wages/insurance benefits, utilities (electricity, water, internet, sewage, trash), rent/mortgage, loan repayment, liability insurance, and so much more.

Your doctor cannot eat that cost and they have to pass the cost on to you, the patient. In many cases, insurance reimbursement is low enough that the only way the doctor can make it work is to cut down the time they spend with you so they can see more patients to pay the bills.

So, chances are that you are going to be paying for at least a chunk of that procedure either in your co-insurance, co-pay, or your deductible. IE paying additional on top of whatever your monthly insurance payments are.

5) Lastly, there may be procedures that your insurance just flat-out won’t pay for even if it’s beneficial for you. So in those cases you are stuck with the full cost of the procedure usually at full price.

Why?!

Because in many cases, your doctor cannot offer you a lower price for those uncovered services as they have legally binding contracts they have to sign with insurance companies saying so.

…Yikes. Well my insurance now may not be great, but at least when I turn 65, Medicare will kick in and pay for all my healthcare needs. I’ll just wait until then to see my chiropractor and have my knee and shoulder finally addressed.

Oh boy. Buckle up.

Did you know that Medicare only pays for spinal manipulation and NOTHING else? Did you know that what Medicare pays for spinal manipulation is often less than what it actually costs a chiropractor to see a patient?

FUN FACT: Medicare will not cover the following services performed by chiropractors:

-Physical exams

-X-rays ordered or read

-Rehabilitation exercises

-Lifestyle counseling

-Nutritional counseling

-Massage

-Passive stretching/mobilization

-Myofascial work

Current medical research shows that the best care pathway for musculoskeletal injury is a combination of hands-on therapy (massage, passive stretching, myofascial work, mobilization), rehabilitation (home exercises/stretches), and lifestyle counseling (nutrition, stress management).

Why doesn’t Medicare cover these things? Call your state representatives and ask.

Wow. I had no idea the medical insurance system was that flawed. So… what should I know about providers who don’t take insurance?

If you find a provider who doesn’t work with medical insurance, this means they have wised up to the flawed system and refuse to let the quality of their care suffer as a result!

Longevity Chiropractic is a great example of this.

By not dealing with medical insurance, we are able to offer you the care you need, not the care you have to accept. There is no guesswork about whether or not a procedure is covered, how long your provider can spend with you, what services they can provide, and you will never receive unexpected bills due to medical insurance not paying out!

Our longer visits cost less cost than any other clinic in the area because we aren’t stuck playing the insurance games. We’re able to focus our time working with YOU to help you get out of pain, return to normal function, and prevent your injury from causing you problems down the line.

So let’s get to work and get you back on your path to Longevity!

Sources:

https://www.medicare.gov/coverage/chiropractic-services

To the patients of Jasmar Reddin DC

To the patients of Jasmar Reddin DC,

I’ve had the privilege of meeting many of you and look forward to spending some quality time with the rest of you! For those of you I haven’t met yet, my name is Dr. Andrew Carper D.C. I am a chiropractor and have been working with Jasmar for a few months now. Please just call me Andy! And if we must entertain the whole doctor thing, then “Doc” will do. Fair enough? 

After working and studying with Jasmar for the last few months, I have some exciting news to share! As of April 4, 2024, my practice, Longevity Chiropractic, has taken over patient care for Jasmar Reddin D.C., P.C. You will see the same familiar faces as Jasmar and Terria have both agreed to stick around for a little while to help me get my bearings before they fully embrace and enjoy their well-deserved retired lives. 

I know I don’t need to tell you how much Jasmar cares about each one of you, because I know you feel it when you come in. It’s not possible to be around her and not feel it. That’s a rare thing these days and is becoming increasingly hard to find in a healthcare provider. I know I will never fully fill her shoes, but I will do my best to continue to learn, grow, and always be working toward the highest standard of care. I work hard to create a safe space in my office and I will do everything I can to help you make the best informed health decisions for your life.  

My approach to health is simple: find the root of the problem rather than chasing the symptoms. 

I treat the aches, pains, and injuries that affect us all from head to toe, with my major focus being on conditions of the head and neck. I’ve struggled with headaches and migraines my entire life and will be the first one to say “They suck.” which is why I have spent quite a bit of time honing my skills to understand and treat headaches. I also have a special interest in treating temporomandibular joint (TMJ) disorders that cause jaw pain as I work closely with my wife Alex, who is a brilliant dentist in NE Portland. If you have a headache and jawache that you can’t shake, I’m your guy.

My treatment consists of releasing tense and painful muscles with a combination of different massage and stretch techniques, chiropractic adjustments, and embedding rehabilitative movement into your daily life activities to help you return to pain-free function. I also believe in an integrated approach to healthcare, meaning a team of multiple providers with varying specialties and educations. I recognize my own limitations and if I believe a problem is beyond my abilities, I will do my best to help you find the right provider for your problem whether they are a medical doctor, nurse practitioner, physician’s assistant, dentist, podiatrist, physical therapist, orthopedist, or any other area of training. I look forward to helping you find your longevity!

A bit about me outside the office: I grew up in a small town in Northwestern Ohio, Tiffin, before getting a communication degree at Wright State University in Dayton, Ohio. Dayton was where I ultimately met my wife, Alex. After a few years working in various unfulfilling corporate jobs, I decided it was time to follow my interests back into the sciences which led me to the University of Western States here in Portland, Oregon. After graduating with my bachelor’s in human biology and doctor of chiropractic, we settled into a life that we love here in NE Portland. 

In my free time, you can find me spending quality time with Alex and our dog, Otter. I’ll either be concocting something in the kitchen, working on the house, making music, listening to podcasts, paddling on the water, or adventuring in the wilderness of Oregon and Washington. Feel free to shoot me an email, give me a call, or come see me at the office! 

I look forward to seeing you soon!

Dr. Andrew Carper D.C. “Andy”

Owner and Chiropractic Physician, Longevity Chiropractic