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Do you take my insurance

“Do you take my insurance….?”

What I would love to say is “YES, we happily take all insurances!” But that’s not true. In fact, until 2018 we didn’t take any insurances, but now we are in network with a few. Here at the start of 2018, the health insurance industry is more volatile than ever, and is only getting worse. What that means to consumers is that insurance companies are finding more ways to push the cost of healthcare back onto consumers, employers and even healthcare practitioners. This isn’t a bashing of insurance companies, but it is meant to educate readers so that they can make educated decisions about who they buy their insurance policies from, and how they use their benefits. Keep in mind that in the U.S., the health insurance industry is booming! Despite what you may hear in the news, they are having record-breaking profits by the billions. Just do a google search on “profit of health insurance companies.” The health industry in general is a profit-driven commodity, which means that profit is often prioritized over your well-being.

I’ve had the unique experience of seeing insurance issues from a variety of perspectives. Of course, as a consumer I’ve had a variety of health insurance policies for me and my family. As a small business owner, I’ve had the painful experience of only being able to afford mediocre policies for my employees, sometimes with companies that did not include my own clinic in their network. As a health care practitioner who relies on insurance reimbursement for the majority of my income, and must comply with a numbing array of individual insurance company policies, I’ve felt the disappointment of not being able to help clients because of their insurance limitations, and also the maddening frustration of spending countless hours of personal time trying get authorizations or payments for our services. And finally, my Dad, a retired health insurance broker, has been able to give me a perspective from “the other side,” which helps to lower my blood pressure, just a little bit.

So here’s the bottom line: Never before have consumers (you) had to pay so much to get so little back from your health insurance benefits. It COSTS you, in copays, coinsurances, deductibles, premiums, lower wages, and more importantly, in your health. If it is expensive to get medical help, you are less likely to get the help you need. This makes it extremely important for you to get real value for the services you choose to spend your resources on. Health care services are not created equal. Those of us in small, private practices know that we must perform well above the standard of the large health care institutions to earn a sustainable market-share for our businesses to stay viable. We don’t have the luxuries of a referral system from a massive organization that profits from referring clients to its own providers, and we can’t afford to engage in costly marketing programs. We live and die by the quality of service that we provide and the relationships we build, which has to be good enough to inspire you to tell others about us. Shop around and find out details of what your services will be. Look at our service model for comparison.

On top of the increasing out-of-pocket costs that consumers are being saddled with, insurance companies are targeting utilization management strategies to decrease their costs. Basically, the less you use your insurance, the more money your insurance company gets to keep. On the consumer side, high out-of-pocket costs make it less likely that you’ll use your insurance. On the provider side, the growing trend to decrease utilization is to make the administrative tasks involved with providing care so burdensome that the providers (doctors, therapists, etc.) give up, or can’t afford to, spend the countless hours of unbillable time trying to get pre-authorizations, re-authorizations, file appeals, etc. Your insurance might say you get 60 visits per year, but if your health insurance company is using Evicore to administer its rehabilitation benefits, you can count on having to fight for coverage to get more than about 10% of your visits, and even that will have extra paperwork for your healthcare provider to manage. The only way your insurance company profits from hiring Evicore to administer your benefits is if Evicore can prevent you from using your insurance enough to not only increase money in the insurance company’s pockets, but to also pay for hiring Evicore as well. I will admit that there are plenty of health care providers who are guilty of over-utilization, meaning they provided unnecessary services to increase their revenue, but that is not what Evicore is working to prevent. They are flat out trying to make it so difficult for providers and patients to use insurance that they either stop treatment or pay cash.

This trend is not sustainable. The high profit margins of insurance companies at the expense of your cash-flow, health, and the quality of service that healthcare workers can provide creates a poorer, unhealthier population. One of the buzzwords in the healthcare world right now is “population management,” which is supposed to imply improving the overall health of our population by giving large organizations chunks of money to be responsible for your health, and healthcare costs. We used to call this managed care back when HMOs were all the rage. The HMO (Health Maintenance Organization) concept did poorly because when they were given a chunk of money to cover all your healthcare expenses, they found ways to not give you service, so that they could keep more of that money in their pocket. Now we have ACOs: Accountable Care Organizations, and it is basically the same concept, only now they are encouraged to try preventing health problems, and there is a degree of patient satisfaction tied to payment.

Even in physical therapy services you’ll see ways for practices to provide services with less cost; scheduling multiple clients at a time with one therapist, use non-clinicians (aides) for providing care, providing low-skilled care that can be performed by aides, overlapping appointment times, extending appointment times with unnecessary procedures that allow unattended billing time, etc. Those are examples of “profit-centered” service models, not “patient-centered” service.

It is hard to not be appalled when you know that insurance companies are having billion dollar profits, and I can’t get more than 6 visits for a knee reconstruction rehab without fighting the same company. Not all policies are like that, but the lower the premium cost, the more likely that is to be true, and right now they are so expensive that individuals and employers are choosing more and more of the lower-premium plans.

Our mission at Prevail Physical Therapy is to provide the highest value of service available. Not all health insurance plans allow that, so we don’t take all insurances. Some insurances make us try to fight for your visit authorization, but we have a policy to engage in “reasonable measures” for insurance authorization, because to do so otherwise enables ongoing bullying from insurance companies. Only when people stop buying such policies will they change, so investigate the insurance product you buy with your agent or HR department.

We committed to this career path because we like to help people. We started this business because we believe we can provide a better service than what is normally available, but it means we cannot succumb to the tactics used to increase profits or offset insurance burdens, so we may not be in your insurance network. We do have multiple payment options in addition to insurance reimbursement; Cash, check, credit card, HSA, FSA, payment plans, pre-purchase discounts, sponsored group discounts, and healthcare credit accounts.

Be sure to advocate for your health insurance consumer rights!


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A funny thing happened on the way to the Olympics…

A funny thing happened on the way to the Olympics…

The path of progress can take a hard-left turn when you least expect it.

At the turn of the century I was working as a physical therapist in a small clinic in Seattle. I had already had one therapy job that ended in the disillusionment that comes from realizing that my primary purpose at work was to generate money for my employer, rather than taking the best care of my patients, and it was happening again in my new job. I’ve always had a disdain for those who whine but won’t do anything to change the situation, so I decided I needed to start my own practice so I could provide the service that people deserved to get. I called a former classmate from PT school, and we started planning to go into business together. It took about two and a half years, but that is how Real Rehab Physical Therapy was born in 2003. We had no idea what we were doing, but we stuck to our service plan, and although the business model wasn’t designed to make us rich, the business grew rapidly. Despite the success in growth, I made a ton of mistakes while learning how to run a practice, but we overcame them with sheer hard work.

My goal was to create an organization that had a reputation not only for providing great service, but also one that was exceptionally innovative in how we helped our clients. We had to learn more than our peers, invest more in technology to push the envelope, and work hard to develop new ways of identifying and solving our client’s problems. That’s a tough plan for a small business with rookie owners, but that’s what I pushed for years. I have a feeling that this push was an important element of our success, but I also think it wore people down in our company, and eventually caused a rift in the owners and the staff. I put blame on others for a while, but really, I have to take responsibility for ultimately failing in that endeavor.

My plan was to create a service model that included a full biomechanics lab, physical therapy service, and performance training. I knew from experience that I was learning amazing things way earlier than conventional wisdom by using the tools and methods of biomechanical analysis that I had immersed myself in, and I believed that if we continued to expand that method of practice, we could become an amazing source of knowledge and education, not only for ourselves and our patients, but also for our peers, the medical community, and the public in general. I still believe that, and it is still my purpose.

I gained some skills that attracted higher level athletes, and in 2016 I found myself accompanying an American decathlete named Jeremy Taiwo to the Olympic Games in Rio De Janeiro. It was the kind of craziness that I love. We had frenetic commutes through Rio to be able to meet with Jeremy between events and do treatments, but squeezed in some sights and Qi Gong on the beach. Of course, attending the games was outstanding, and despite all the challenges that Jeremy had to overcome just to make it to Rio, he made us proud.

It was really a great experience that I thought everyone back at my clinic should get to experience, so I started planning how I could make that happen. That wouldn’t happen though, at least not at my old clinic. My business partner and I had been having problems. We were having growing conflicts about a lot of things, and it turned out that my trip to Rio was the last straw. When I returned I found out that one of us had to go. I had put an incredible amount of myself into this organization. I won’t call it a sacrifice for myself because of the invaluable lessons I learned, but my family had huge sacrifices put on them by the experience. We were really close to being in a position to make the next big leap to my original plan of lab, clinic, performance center within a couple of years. But my vision was no longer the vision of everyone else there. I had been struggling with how to regain traction for my plan, but it became clear that it wasn’t going to happen with Real Rehab. So I left.

I have two kids, and leaving Real Rehab felt like I was abandoning my children. Worse, I felt like it didn’t need to happen, but it was beyond my control. I spent all of 2017 working on myself and my family. It took a long time to realize that my original goals with Real Rehab are in fact my purpose, and I am compelled to achieve those goals. I had an incredible amount of sadness and anger over the “loss” of Real Rehab, until I realized how much I had gained from the experience. I learned an immense amount, which is part of my mission. I had the opportunity to work with amazing staff, and I was blessed to be a part of countless inspirational stories of clients from kids to Olympians who were able to prevail over their challenges and reach their profound goals.

I’m grateful for that loss. I learned one way not to achieve my goal. I made hard run at it, hit a wall, regained consciousness, and found a way around the wall. Now I’m running toward my goals again, and I’m running with people who are running in the same direction. I used to have two Alaskan Malamutes that pulled a sled for me. When they pulled together they had incredible power. When they didn’t they toppled me and the sled. Same goes with people. The team I’m on will only exist by pulling together. We have a long way to go, but we’re off to a great start, and as Margaret Mead said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

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2018 Kickstart; Reservations about Resolutions

2018 Kickstart: Reservations about resolutions, and “The One Thing”

I have mixed feelings about New Year’s resolutions. On one hand they are cliché, and we shouldn’t need an arbitrary calendar date to make positive changes. On the other hand, making change is hard! It takes courage and consistent effort to escape the rut of old habits. It takes momentum to break out of the orbits of our comfort zone. So as tired as New Year’s resolutions are, and even though they are rarely maintained, if making such a resolution provides the catalyst you need to finally make that positive change, then more power to you. Better to try and fail then never try at all.

Last year I read a book called “The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results,” by Gary W. Keller and Jay Papasan. It’s a worthwhile read, but I’ll summarize one of my key take-aways as this: The results of our efforts in life come from our habitual behaviors, so the key is to create in ourselves the habits that produce extraordinary results. Now there’s much more to the book, so read it yourself, but in the spirit of New Years we’ll just talk about the habit part.

Gary and Jay talk about how it takes, on average, 66 days of repeating a behavior to make it a habit. To maintain  that behavior takes a quantum of discipline, but we only have a finite amount of discipline available. The trick is to make the desired behavior a true habit, because once a behavior is a habit, it takes very little discipline to maintain. I love that idea. Since we have limited discipline, they suggest working on only one habit at a time. I did that, and it went ok, but I’m still not satisfied. The habits I want to develop, while simple, allow me to make huge positive steps in all areas of my life, so I want them all, right now. I’ll tell you what they are. And I’m doing them all, every day, I don’t care what Gary and Jay said, because I’m fifty-one years old and I don’t have a lot of time to waste. They are;

10 minutes of exercise every day

10 minutes of meditation every day

Less than one hour of television every day

Eat only between the hours of 11:00 a.m. and 7:00 p.m. every day

They are so simple they sound stupid, right?! Well, in the past I’ve had great success with each of these habits, so I don’t care how stupid they are, they work for me. If I can start 10 minutes of anything I usually turns into more. I’ve never admitted publicly that I am easily hypnotized by TV, so less than an hour is great for me and frees up a LARGE amount of time for me to do other things that drive my progress (sleeping, writing, studying, family, exercise, meditation etc.). The eating thing makes my nutrition plan much easier to carry out every day, and helps me be a fat-burner.

So despite the New Year’s resolution naysayers, I sat down on January 1st and made a spreadsheet to track each of my habits, every day. And because I’m a little hard-headed, I made it for 99 days instead of 66 because I want them to stick.

What habits do, or would, make big differences in your life?

By the way, January 2018 is huge for Prevail Physical Therapy, check out this blog post.