Do you like the title?   Technically, they didn’t actually make me write this letter.  However, as part of the agreement I signed when I applied to be an in network provider 10+ years ago, it was in the fine print that I have to send out a notice if I ever terminate my contract with them.  Hey, it’s only fair.  They allowed me to put up with their periodic cuts in reimbursement all while doing extra work to get that lesser pay, and while telling me how I should be treating people they’ve never seen before, all from their office located in California.  It’s the least I could do in return to make up for it.

I have agonized over the decision I describe below for years.  On two occasions, maybe even a third, I contacted them or the primary plans to try to negotiate a slightly higher reimbursement rate. I wasn’t even asking for a raise.  I started in 2005.  A 20-30 minute office visit would be reimbursed at around $55.  Today that number is averaging less than $36. For some plans,it’s $26.  I would have settled for $45. Not so much as even a response in way of a form letter.

So, although I know you all pay a lot for your health insurance, I had to make this decision.  Given that many of you have $40, $60, and even $80 copays, it may not really affect you that much.  My basic office fee is around $40.  If you have a plan as described below, you pay the fee, I give you the receipt, and you can submit it for out of network benefits if it’s worth it. In return, I will treat you as I think you should be treated. I don’t have to worry about the insurance company telling me I can only see you X number of times.  I don’t have to worry about trying to see 8 people an hour just to pay to keep my lights on.  I don’t have to worry about killing my poor office manager because she has to argue with the insurance company because they messed up yet another claim.

Without further ado, here’s the letter the insurance company made me write 🙂

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*This letter was sent in the mail yesterday to everyone I’ve seen with ASH plans over the past 10 years.*

To my patients (past, present, future),

Recently, I made the decision to terminate my contract with American Specialty Health Group, Inc (ASH).  This is the third party agency that administers claims for several local health insurance carriers including Capital Blue Cross, Cigna, and Geisinger.  This change will be effective for all visits after July 16, 2016. This only applies to those patients with one of the plans mentioned above.

This decision was not taken lightly. The reimbursement rates, paperwork, and other requirements have been negatively impacting my practice for at least five years now.  As an example, some of these plans pay $25 per visit, no matter how much time is spent with someone and no matter what procedures are performed.  Compare that with when I first started practice 11 years ago.  The average visit reimbursement was about $55. Being that I spend about 20 minutes with each of you, the total amount reimbursed makes it such that I would need to reduce the amount of time spent during each visit.  Insufficient time with doctors is one of the main complaints I hear from people, and seeing more people in a shorter amount of time just does not jive with my practice philosophy and type of approach. Additionally, my staff is burdened with submitting, resubmitting, and appealing claims that should have been paid the first time.  Not only is it a waste of time, but it is stressful. Rather than let that continue to affect their health, and for other reasons noted above, I made the decision to make a change.  

So, what does this mean for you?  If you have received this letter, it means you either have or have had insurance through one of the carriers noted above.  We are contractually required by ASH to notify in writing everyone that we have seen over the years with one of these plans.  This is your notification that as of July 16, 2016, we will no longer be contracted with ASH and therefore any claims submitted will not be eligible for reimbursement as a contracted provider. If you have changed health plans and currently are covered through Highmark for instance, this does not apply to you. It’s only for the plans listed above.

If you still have one of these plans and need an appointment, you may continue to see me.  Each plan’s out of network benefits vary, but we can supply you with a receipt that you can then submit to your insurance company for possible reimbursement. Fees range from $40-60 on average and depends upon the exact services rendered. As a comparison check your copay and deductible. It’s not uncommon for us to see copays of $40, 60, or even $80 and deductibles of $2-4,000.  If this describes your plan, out of pocket expenses with me will not be much different vs. a contracted provider.

If you would like to use your insurance, you may see the other chiropractor that works out of our office. Dr. Tom Rottet is independent from my practice and still contracted with ASH. We are very similar practitioners, so the transition should be smooth. To schedule with him call the usual office number 570-366-2613 and ask to be seen by him.  Just be sure to let the staff know you will be seeing Dr. Rottet for the first time so extra time can be scheduled in order for him to become familiar with your case. If this is your decision, I completely understand. If your situation changes, you can always switch back.

If you have any questions, please call the office at 570-366-2613 or send an email to me at info@bmfchiro.com. I’ll be more than happy to address any questions or concerns.

I sincerely appreciate all of those that have placed their trust in me over the years. It was a difficult decision as ultimately you all pay the price, but I feel it was necessary in order to provide the best care possible and not suffer the pitfalls that many providers succumbed to in order to conform to the insurance industry.

 

Sincerely,

Buddy Touchinsky, D.C.