I do believe as well that some offices use prepayment plans responsibly, But from what I have seen thus far I am still not sold on them. While not everyone is insured, many people do work hard and pay a lot of money for health insurance. A massive investment in healthcare that isn’t covered by insurance treads into fishy water. The predefined treatments may allow the patient to seek care regularly as well as be tied into a long term treatment plan, but it can also provide stress in other areas, particularly financial. Depending on the payment, I am also weary on how much of a discount (if any) these plans offer. As a mentioned, with our office fees (which are fairly mid-level) someone can be seen 20 times without insurance and still not break the $1000 mark. If the programs I have heard of in the past were under $1000 then we’d be on the same page, but I frequently see numbers ranging from $2000-$3000. I do not understand how anyone can justify that cost, which was the reason for the post.

The posting was to serve as a PSA for the dozens of patients I have seen who fell into this trap (I’ve been practicing for a year, it comes up way too often.) I know there are many doctors operating under real ethics who use the plans to reach populations that are underserved or would could benefit from a cash based plan. However, I cannot stand seeing the minority (I hope minority…) of offices take advantage of these patients. I think as a profession we can do better.

Always happy to see you reading and taking part in the postings Dr. Duncan, and glad to hear you’re operating with the patient in mind. My hope is that more of our colleagues will follow suit.

Speaking about decompression, the research indicates that to achieve best clinical results about 20 visits is a minimum. Much of the research recommends daily visits initially, but 3 times a week, again, as a minimum. Tapering off treatment nearer the end is also recommended. If doctors follow research and vary only slightly due to patient need then minimum treatment could easily run 2-3 months. If the doctor is also doing appropriate re-examinations to make sure the patient is progressing as expected then that treatment plan would easily add up to thousands. Providing a discount to payers by allowing them to pay up front allows them to pay less than they otherwise would. This is for the benefit of the patients wallet as well as their health both offering a discount in cost and following evidence based guidelines. In the few states that I have practiced in it is also required by law to refund the remainder of prepayments if not used and inform the patient of that option prior to taking such payments, thus allowing the patient freedom to withdraw from the prepay.

Another side benefit to the patient is that they are also more likely to complete the full treatment plan having already paid for it. Some times patients will stop coming before their treatment is done because they “feel good.” Similar to the patient who stops taking their antibiotic medication before they are supposed to; they may do more harm than good by not finishing their treatment. It may end up costing even more if the issue is not fully resolved and they then have to get further, possibly more complicated treatment.

I don’t like prepay plans, but use them occasionally for patients who could not otherwise afford care. So there are docs out there doing prepay plans because they are looking out for our patients and not for their wallets. I’d be happy to discuss further if interested.

Now let’s address what you did do. Maybe you got lucky and things moved where they should, but more likely you just got a crack sound somewhere, but the joint that needed motion is still not moving as it should. The person feels an endorphin rush and feels better for maybe 20 min. or so. Then the pain comes back and they keep trying to crack it because it felt better the first time. They may keep doing this until they develop another joint near the first problem, that is now moving too much. So now you have 2 problems that are much more difficult to resolve. There’s so much more. I think perhaps I’ll go write my own blog post on the topic. Let your chiropractor be the one to adjust you, and ask him what you CAN do on your own to provide relief. He should have some great tips that won’t end up hurting you or getting you sued.