Why Insurance Might Be Hurting Your Healthcare

Hey guys! Dr. Nagy here. I wanted to share with you my perspective and my patient’s perspective on health insurance in general. It’s one of the things I get asked about most when patients call into the office or come in for their discovery visit, so I think it’s important that I share my thoughts on the matter.

Let’s be honest. Navigating the world of health insurance can feel like running in circles, and this isn’t just the case for patients, but providers as well! You’re not alone if you’ve ever been hit with surprise bills, denied coverage, or found yourself confused about what your plan actually covers. As a chiropractor in Fairfield, CT, my hometown, I made a conscious decision to not accept insurance. This isn’t because I want to limit care, or line my pockets, but because I want to deliver higher quality care to my community. 

I can guarantee that many of you are reading this and thinking that using your insurance is your best course of action (especially from a financial perspective), but going outside of the insurance system is often the best decision for patients. At least that’s what I have heard from the people that I have worked with. 

The Illusion of Coverage

The reality is that insurance companies don’t really care about what you actually need. As I’m sure you are familiar with, insurance companies determine how many visits are “necessary,” what treatments they’ll reimburse and who and what conditions qualify. Unfortunately, these decisions are driven by what’s best for cutting costs, not necessarily what’s best for your health. 

For instance, many plans only cover chiropractic care for acute injuries or limit visits arbitrarily. Insurance companies will even choose what type of treatments they will pay for. For instance, Medicare actually won’t cover anything more than spinal manipulation for a patient. Hoping for comprehensive care that focuses on getting your moving and not just relying on hands on modalities; get ready to pay out of pocket for that! As you can see, insurance not only limits the care you have access to, but also makes it difficult for your chiropractor to care for you the way they would like, and more importantly, the way you deserve. 

More Insurance = Less Time With You 

If a chiropractor doesn’t take insurance, it doesn’t mean they are wrong or any better or worse than someone that doesn’t, but the reality is you’ll rarely get the care that you deserve, that will bring you to a place of resolution, and not simply symptom management. 

The average insurance-based provider sees 25-35 patients per day, often 7-15 minutes per visit if you are very lucky. Why? Because insurance reimbursements are low, and the only way to keep the lights on and stay on top of dealing with the insurance companies is to cram the schedule. Sure your chiropractor in this scenario is still caring for you to the best of their ability, but it looks like damage control more than anything. At my practice Thryve Chiropractic, I set the schedule based on your needs, not a billing code. We spend the necessary time assessing, treating, re-assessing and working on long-term goals as a team. No rush, no red tape. 

As an anonymous physician from MedPage Today wrote in their article titled “I’m a Doctor and I’m Burned Out - Because of Insurance,” “we’re forced to treat the chart, not the patient.” I don’t know about you but I would rather be a patient when getting cared for, not just a muscle strain or ankle sprain in room 2 that needs to be attended to as quickly as possible in order to care for the next patient on the schedule. 

Transparency and Trust

Here’s something radical that should be the reality across the board: knowing how much your care costs before you receive it. By not taking insurance, I can offer transparent pricing without surprise fees or co-pays. In many cases, patients at Thryve Chiropractic end up spending less than they would if they went through their deductible anyway. It was found in 2023 that the average deductible for an individual insurance plan was over $5,000, and most of my patients never hit their deductible anyway, so they automatically have to pay out of pocket AND deal with the paperwork involved. With a direct-pay model, you know what you’re getting, and what you’re paying for every visit. 

While you may think insurance companies are on your side, there have been numerous instances that highlight how untrustworthy they can be. In 2022, Advanced Physical Medicine of Yorkville, Ltd. filed a lawsuit against Cigna for denying coverage of a third of the requested chiropractic visits that a chiropractor had requested for their patient. Despite the treatment being deemed medically necessary by the insurance company, they ended up denying coverage by simply labeling the condition as chronic and arguing the doctor was providing insufficient documentation of improvement. You deserve better than that. 

The Patient Comes First

When I work directly with patients, not taking insurance allows me to not worry about whether a treatment fits a certain billing requirement. Don’t think I won’t worry about if it’s right for you, these are two different concepts. I’m 100% focused on your body, your goals, and your progress, period. Whether you are recovering from an injury, managing chronic pain, or working toward a performance goal, care plans at the office are built around what actually helps you thrive, not what gets reimbursed and makes you feel good for a little while. 

Also, by not taking insurance the patient really does come first. Instead of waiting weeks for treatment because one of your providers is stuck getting authorization, you can be rest assured that there will be no delay in your care. If you need it, we schedule it. Simple as that. 

Accepting Insurance vs. Working With Insurance

At my practice, we’ve chosen to not contract directly with insurance companies, but that doesn’t mean we leave you hanging. Instead, we provide detailed superbills that you are able to submit to your insurance company for potential reimbursement. This gives you the ability to capitalize on your benefits without sacrificing the quality, time or personalization required to get you the outcome you need. It also means we don’t have to let insurance companies dictate how long you can be seen, what treatments are approved, or how we structure your care.

By working with insurance, rather than being bound to it, we stay patient centered. You receive high quality care tailored to your body and goals, and we provide everything you need on the insurance side of things. Many of our patients are delightfully surprised by how simple the process can be, and how often they’re reimbursed, especially when they have out of network coverage or FSA/HSA accounts. It’s truly the best of both worlds. 

Final Thoughts

Investing in your health is empowering. 

Not taking insurance isn’t about making things more difficult, it’s about cutting out the middle man so we can focus on what matters to you. This unique model that is seldom found in chiropractic offices affords you longer visits, personalized care, transparency, direct communication with your provider and freedom from financial or arbitrary limitations set by an insurance corporation.

In today’s healthcare system, choosing to go outside of insurance might be the most empowering choice you can make. It’s your body, your health, and your decision. 

I am always ecstatic when a patient decides to work with me, because I know that the care I’m giving them is what they deserve and what I would expect for a child or family member of my own. If you are ready to experience the difference, schedule your free discovery now.