Nationwide Trend in Insurance Coverage Opens Doors for Acupuncturists to Expand Their Practices (Pt. 2)

Editor’s Note: Pt. 1 of this article appeared in the July issue as a web exclusive.

For acupuncture bills – which can be denied by insurance, even for personal-injury protection (PIP) coverage in some states, you can recover your full retail rates in PI.  You avoid the insurance battles and the PIP battles. (You still will have the attorney battles, but there are tools, methods and coaching programs to help for that!)

And that’s why acupuncturists who understand PI can expect it to be the best-paying segment of their practice. Long story short: You don’t have to reduce your bills. Period. You may want to, depending upon the individual circumstances, but it is your choice.

The even better news is this: Some of the pressure is about to be lifted. Attorneys (and their clients/your patients) will have a bigger pot of money to collect from. More cases will go to trial as a result, likely increasing settlements and allowing for more successful verdicts, so attorneys might not be quite as threatening when it comes time to pay the medical providers.

First Act: Position and Protect Yourself

If you are not practicing in PI, now is the time to dip your toes in the water and get the lay of the land. Once you understand PI, setting the stage for success is simple. You can and should put things in place that best position your bill recovery and protect your practice. You need to learn how to:

1. Use a rock-solid lien or LOP. This is your foundational contractual agreement through which all rights and obligations flow. Your lien, which you should ask both the patient and the attorney to sign, should make it abundantly clear that the patient owes the full balance of the bill, regardless of the outcome of the case.
2. Communicate transparently with the patient and the attorney. You can do this in writing and via conversations. For instance, during the patient’s intake, you can let the patient know that unless they have talked to you directly and have it in writing from you, they should assume that you expect your bills to be paid in full; and that they should verify with you if the attorney is telling them otherwise.
3. Send monthly statements to the attorney and the patient. Include a fee comparison. (Check out FairHealthConsumer.org as one resource to compare fees.) This fee comparison can support your fees and helps the attorney defend your bills to the insurance adjuster during settlement discussions. Bill support also gives you leverage to push back if the attorney tries to play one of their favorite tricks: Using your bills to force a payout from the insurance company, and then turning around after the case concludes and asserting that your bills are unreasonable. If you have sent regular statements, the attorney had plenty of opportunities to let you know if they disagreed with your treatment or the reasonableness of your charges.
4. Comply with the No Surprises Act (NSA) and include a good-faith estimate (GFE) when you begin treatment in a PI case. Although this new law might seem like one more regulation that you need to follow, in fact, it’s excellent news for acupuncturists. It works like this:

• The patient’s attorney will look at your good-faith estimate, and he or she will tell the patient, “Yes! Do that.” After all, your medical treatments will help the attorney prove the patient’s claims of damages.
• The attorney’s endorsement will validate your billing and your treatment and position you as an expert. This gives you an opportunity, during treatment and post-discharge, to teach your patient about the many ways acupuncture can help them and those they know treat or prevent other ailments. In other words, it gives you an opportunity to teach them about term wellness care.
• Speaking of which, a large segment of your business likely consists of per-visit patients, but the NSA’s requirement for GFEs changes the mindset of your patients. After all, a GFE is required for recuring treatments of self-pay patients, and must therefore be supplied for most PI patients, including those with medical expense or personal-injury protection (MedPay or PIP), as those aren’t guarantees of payment. When you have successfully treated them for their personal-injury ailments, you will be better positioned to transition these patients to long-term wellness care patients.

Wouldn’t it be nice to have a significant number of your appointment slots filled in advance? The NSA lets you more easily turn this dream into a reality, as PI patients are trained in a new habit: term care plans.

Action Steps: What Are You Waiting For?

The new rise in minimum insurance trends across the country are going to lift an already profitable practice segment even higher, so the time to rejoice is now. It’s also time to take action!

• If you aren’t in PI, get in. The business rule of thumb is: Follow the money, and the money is in PI.
• If you are doing a little PI, beef up this segment within your acupuncture practice!
• If you are doing a lot of PI, use your PI practice segment to increase the wellness side of your practice by taking advantage of the NSA and the wonderful synergy between injury and wellness care.