As a Doctor of Chiropractic, before ObamaCare, we were paid for our services without constantly having to check benefits to find out what kind of tricky plan the insurance companies had set up.
Hereโs what the insurance companies have done in the state of New Jersey, using Horizon Blue Cross Blue Shield as an example, to confuse their customers: In New Jersey, 99% of chiropractors are deemed Tier 2 providers. When the insured looks at their benefits, they see that they are entitled to 30 chiropractic visits per year at a specific copayโletโs use $30 as an example. The patient comes into the office thinking they have 30 visits a year and that each visit will cost them a $30 copay with no additional responsibility. After all, they are paying for these benefits.
However, what they donโt know is that the chiropractor has been unfairly and prejudicially deemed a Tier 2 provider for the insurance companyโs profit. As a Tier 2 provider, the patient has a $3,000 in-network deductible. Yes, you read that correctlyโwith ObamaCare, they developed the scheme of charging an in-network deductible. In the past, a deductible was only applied to and penalized those who went out of network.
Regarding in-network providers: The doctor signs a contract with the insurance company to become an in-network provider, accepting a lower fee schedule in exchange for the promise of being sent patients through their large network. The insured patient is rewarded for staying within the network. However, insurance companies now scheme to charge an in-network deductible without the patient realizing it. Additionally, the doctor who is in-network is contractually obligated to collect the deductible at the time of service to avoid breaching the contract.
Letโs break this down further to illustrate how the insurance companies play the statistics game. On average, a chiropractor can collect approximately $100 per visit. If the patient has 30 chiropractic visits at $100 per visit, that totals $3,000. Guess what Horizon Blue Cross Blue Shield made the deductible for ObamaCare patients? $3,000.
What theyโve done is have committed fraud by making patients think they have coverage when, in fact, they do not. All of these fees come out of pocket. Once the out-of-pocket deductible is met, the patient no longer has any visits left. Itโs a surreptitious scheme to maximize profits for the insurance company.
Now you may be asking, how does one become a Tier 1 provider and not be subject to this in-network deductible? Well, a chiropractor would have to be on staff at a hospital. Thatโs why I said 99% of chiropractors in the state of New Jersey are considered Tier 2 providers and penalized along with their patients. The 1% of chiropractors who are staffed at hospitals in New Jerseyโwell, you know the old saying: โItโs not what you know, itโs who you know".