Madison Manual Medicine uses a cash-only business model. Our rates ($90/hour for 2014) are markedly lower than billing for visits at a typical healthcare clinic or office. Rates would have be much higher for us to cover our costs if we were to maintain staff and procedures to interact with insurance companies.
A brief explanation of my philosophy
The U.S. medical system is disease and diagnosis-based. Insurance reimbursement is heavily structured around performing procedures. Insurance reimbursement for osteopathic treatment is based on the number of anatomic areas treated in a given session, which can be numerous. As a provider I would rather contract directly with the patient to pay for an hour of my time. The incentive remains to find the best way I can apply my skills in a way which meets the patient’s needs, rather than treating more regions to increase an insurance bill.
Insurers also often deny manual medicine treatments, creating a significant amount of hassle and time spent trying to procure billing reimbursement. I would rather spend my time treating patients as opposed to negotiating with insurers. If this office needs to generate a bill for insurance purposes, it adds costs typically higher than my hourly charge. These costs come about by the need to have either billing-specific employees or a contract with a billing agency to complete the necessary paperwork.
For example, one individual in a car accident may have problems with post accident headaches due to shifting in the bones of the head and face and the lining around the brain. If those are the only structures involved, as a provider I should focus my energy and treatment exclusively on the head. A different individual might have also have headaches but instead of being anatomically limited to the head, they might also have issues with their neck and tension on the connective tissue attached to the bottom of the skull that continues into the chest and abdomen. To appropriately treat this patient I would identify the scope of the problem and address the components in turn as time allows. Regardless of the nature of the injury, the patient receives an hour of provider expertise and time. In my opinion, the second patient’s charge should not be higher than the first patient’s.
