In my office, I use the following analogy with patients to help explain why I use direct payment instead of third party insurance. This is only one way to look at it, and like all analogies, it does have some aspects where the analogy breaks down:
Let’s say you go to your local car service shop to get your oil changed. It has been over a year since the last one, and you finally think it might be time to remedy that dark smoke emitting from the tailpipe. Upon doing their full-service check-up, the mechanic also recommends four new tires since the ones you have are worn down to the rim.
It is also determined that your brakes are shot; that loud screech sound you’ve been hearing when you pump the brakes is not normal. And finally, after ignoring the check engine light for months, it is determined you need a new water pump to prevent your engine from constantly overheating.
After the price is totaled, you kindly ask the service shop to bill your car insurance to pay for the repairs. With a polite and emphatic “no”, they inform you that these types of repairs under these types of circumstances are not covered under your car insurance.
Now, this is an extreme example, but it proves a valuable point of how insurance policies operate. Just as not all services that provide care for your car are covered under car insurance; not all services that provide care for your health are covered under health insurance. It is well known that car insurance policies do not cover any costs associated with routine vehicle maintenance.
What is maintenance? Maintenance is the process of preserving the integrity of someone or something. So car insurance does not pay for costs associated with preserving the integrity, or condition, of your car. How well your car is conditioned is the most important feature of its health. How well your body is conditioned is the most important feature of your health.
Chiropractic care is concerned with the routine maintenance of the nerve system and its relationship to the spine. Preserving the integrity of the nerve system, especially at the brainstem level, is crucial for the condition of your health. The health insurance model at this time does not include routine maintenance, so Chiropractic falls outside the insurance payment system.
Health insurance does serve a purpose under certain circumstances; it just doesn’t serve the main purpose of preserving or maintaining your health. This is the paradox of health insurance. It would be better labeled and understood as “sick-care insurance”.
Yes, I do take care of people who are sick, but I do not treat their sickness. And if I am not treating their sickness, billing insurance for my service would be fraudulent. I would be billing the insurance companies under false pretense.
This might seem like an extreme interpretation, but if one is to adhere to the principles of Chiropractic, one must anchor themselves to those principles. This is a defining difference between chiropractic care and medical care. Medical care is not concerned with maintaining health, but with treating sickness.
This is why the majority of medical care providers can bill health insurance. Maintaining health and treating sickness are not synonymous. The care I provide is designed to promote and maintain health, not to treat any sickness.
I don’t want to make it seem like I am completely against insurance in general or health insurance in particular. In unforeseen or unavoidable emergencies, insurance can help cover the cost of injuries and the damages that can occur. God forbid, if a major traumatic event leads to a crisis situation, insurance should be there to help pick up the pieces.
But to rely solely on health insurance for our health, is to wait for a major traumatic event to happen and then hope someone will be there to help pick up the pieces. This takes your health out of your hands. Maintaining health takes effort, an effort we must all be willing to strive for on a daily basis. To sit back and wait for health to come will find it never arriving.
Jarek Esarco, DC, CACCP is a pediatric, family wellness and upper cervical specific Chiropractor. He is an active member of the International Chiropractic Pediatric Association (ICPA). Dr. Jarek has postgraduate certification in Pediatric Chiropractic through the ICPA. Dr. Jarek also has postgraduate certification in the HIO Specific Brain Stem technique through The TIC Institute. Dr. Jarek is happily married to his wife Regina. They live in Youngstown, Ohio with their daughter Ruby.
