By Christian Livermore
Posted: April 06, 2009 – 2:00 AM
TOWN OF WALLKILL — A local chiropractor fed up with the hassle and underpayment by insurance companies is switching to a cash-only practice.
Dr. Peter Holst said insurance companies are paying less of the cost of chiropractic visits, making patients pay more and drowning doctors in red tape.
Some require a preliminary exam to document the need for treatment, but won’t pay for it. Some deny payment for inexplicable reasons. One allows a $29 fee for a basic visit, but sets the patient’s co-pay at $40. Insurance company payment: Zero.
“I hate the thought that me cutting out insurance might impact my patients and the trust and confidence they have in me, so any fee that we establish will be in line and close to any co-pays they are already paying,” Holst said. “Why do I have to waste my time dealing with insurance companies when they’re not paying for anything anyway?”
He plans to make the switch in the next year, and is still figuring out what his fees will be.
Holst is one of what seems to be a growing number of doctors who have thrown up their hands with insurance companies.
“We have heard anecdotal evidence of a rise in the number of cash-only practices,” said Angela Kargus, spokesperson for the American Chiropractic Association.
It’s hard to pin down exactly how many cash-only doctors there are nationwide, but an annual survey by the trade magazine Chiropractic Economics showed that in 2008, 8 percent of survey respondents were cash-only, compared with 7 percent in 2007. But the number has seesawed up and down: 21.1 percent in 2006, 11.7 percent in 2005, and 6.4 percent in 2004.
Other doctors have switched to “boutique” or “concierge” practices, where patients get unlimited visits in exchange for an annual fee.
Some dentists are making the switch, as well.
Town of Wallkill dentist Dr. Donato Napoletano still accepts insurance, but dropped all managed care contracts about 10 years ago, fed up with the lower fees the insurance companies paid through contracts, fees that barely covered his expenses.
“I could not spend sufficient time with patients because I had to get a certain number of patients in to meet my expenses,” he said. “I just reached a point where I said, this is not why I became a dentist.”