Prepay Plans – Are They A Barrier to Care?

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Hey, greetings everyone. This is Sam Collins, your coding and billing expert for acupuncture and the American Acupuncture Council, the network, as well as the insurer. And as always, we're here to try to help you fortify your practice, make things better. It's a great time to be an acupuncturist. It really is.

There's never been a better time. However, we have to figure out how do we make all these things work? How do we meet it up? How do we start to decide that we run the business end? This is the difficulty, I think, for many acupuncturists because you get through school. You do a good job to become the best acupuncturist possible, help people.

But then you have the reality of uhoh. I've gotta run the business end. That's where my specialty comes in cuz we deal with the coding, the billing, but also all ends of it. And I wanna talk a little bit today about running parts of your practice as a cash practice, not just insurance. And how do we deal with that?

What about prepay plans? Let's go to the slides, let's talk about that. What are or. Prepay acupuncture plans. What is possible for us? What can we do with it? How do we make sure it's legal? I think you've seen things like this. Here's what I always think of. We have to provide a way that allows people access to our care.

And I think this is often where we run into problems, is not always understanding why aren't people coming to us? So let's look at it. Why do people not get acupuncture? Let's think of that. Think of that and solve and think even your friends, what do they even know that you do? Some people will say, I hate needles.

Some could be, ah, it's not gonna work for me. Oh, they're not real doctors. But let's base on what's really changed. The Cleveland Clinic, one of the most renowned places for healthcare in the US recently published that says this, what type of pain does it? Acupuncture treatment. It says, many people use acupuncture to relieve pain throughout their body.

Including for migraines now, notice pain throughout the body, including migraines, back pain, arthritis. Studies have also shown that acupuncture may be his successful treatment option for a variety of conditions, including immune system issues, infertility, and the effects of menopause and so much more.

You are now able to access people in ways that I think 20 years ago, acupuncturists probably could never. Have thought of because the people now understand it. You gotta wonder, do people really know what you do? And this is something I'd like you to ask yourself and your family. What do I do?

Because I want you to think of what does the average person think? Now notice I said ask your family. Your family who's, who loves you. I bet many of them don't really understand what you do. And I'm not blaming anybody, but saying we have to do a better job of making sure people understand the why of acupunctures, the things you can do.

So think of it if someone went by your office. Would they know what you even treat? If it says acupuncture, you're assuming they know. Notice these two offices I use as an example that talk about what they treat. Fatigue, stress, tension, anxiety, depression, mood swings, migraines, tension, headaches, digestive disorders, indige.

Congestion. Allergies, asthma, cough, women's issues, neck, back and knee pain, arthritis, autoimmune, chronic, even va. What about personal injury? What about for that matter, Medicare. Medicare Advantage. Look at this other one. Neck and shoulder pain. What my point is, Why are people choosing acupuncture?

Partly because they're not sure it can help cause they're not aware that it could help 'em with menopause and frankly, whether an insurance covers it and some will. If you can help a person having issues with hot flashes and other issues. Is there a value enough to pay for that? I believe so.

But realize the barrier to care for most people, as we're well aware in the us. Cuz my goodness, we have a diagnosis code. This is an actual ICD 10 code. It's a P, it's a code that indicates patients noncompliance with other medical treatment and regimen due to financial hardship. How many of us know someone that needs to go to the doctor?

We, we know they do, but they don't. Why can't afford it? Don't have insurance. So that puts a dilemma here that realize a lot of times people aren't choosing care because it's just a factor of affordability. That's what a capitalistic society does. I'm not blaming it, I'm just saying that's a reality. So you think what about if they have insurance?

Insurance can be good. There are some plans that pay very well. There's some plans that are horrible, meaning they pay, but very little. But keep in mind, there's still gonna be sometimes no or limited benefits. Maybe the plan has a super high deductible. Okay. Or maybe there's just no insurance out.

Patient doesn't have anything. They don't have a job that gives them insurance, if you will. While many people do, even when they do they have a coverage? Think of a Walmart worker. Do they have insurance coverage? Oh, sure they do. But do they have acupuncture benefits? Sure they don't. Unfortunately. So here's where I think we need to bridge is acupuncture, I think has always done a good job of not relying on insurance.

Not to say you don't take some insurance. The good stuff. Sure. But you don't rely on it because we know coverage patterns for what you do is not as well covered. That's gotten a lot better, particularly in some states, but data suggests people are more willing to pay out of pocket for acupuncture than just about any of their service, cuz they're used to it.

But there's also a cause and effect I think. I want you to think of, if you've ever been to a medical doctor, have you ever left going, God, I feel so much better. And I'm not saying that is a putdown, that's not how they treat. How many people come to you in a day that have a pretty severe amount of pain, a headache or something, and when they leave they're like, oh my God, it's 75% gone.

I'm not saying we've cured them in one visit, but you get my point. There's value to that. So you gotta think someone's coming in. How do I offer that in a way that they can afford it? What about discounts? And I think you've all talked about I'm gonna offer a cash discount. You can certainly have a, just a cash fee.

That's whatever you want it to be. I. Unfortunately, if you're billing insurance, it really can't be much different. Remember, when you are billing insurance, your cash fee can't be any lesser or any greater, excuse me, than would be five to 15% according to the Office of Inspector General. So that's under federal rule.

So you give a small discount, but not much. So does that really help? What if you're charging $150 and all of a sudden the patient goes do I get a cash discount? Yeah, sure. We make it 1 35. That still may not be affordable for them. So is there anything else we might do? That's where pre-pay plans will come in.

Let me give one exception because obviously I'm gonna have providers from all over. Remember, California has an exception to cash discounts business and professions code 6 57. So in California, yes, you can offer a substantial cash discount as long as they're not using insurance. But California's unique in that no other state has that.

But here's what I'm thinking of. You're a business. You gotta think of it like a business, and this is where prepay comes in. Sears made a major mistake 20 years ago or so. Sears, someone at Sears should have looked and go, wow, this Amazon business is really booming and all they've done is copied us.

Amazon has nothing more than a copycat Sears. Sears was a catalog company and you ship things. They moved away from it when City Center started, but why didn't someone at Sears go, Hey, let's digitize this catalog, because at Sears done that. Do you think Sears would still be around? I think so. Because would you still buy from Sears if they could ship it right away?

Of course we would. In fact, what's funny is all those big Sears stores, many of them are turning into Amazon warehouses, which I think is funny, but it just means they did not adapt. I want you to think of adaptation in your practice. What have you done that could be helpful to a patient to get more access to care?

I give a cash discount, eh, but I want you to think of, there's a very popular group right now. That is probably the biggest growth of acupuncture for any place, and that's the company, modern Acupuncture. How does modern acupuncture work? Excuse me. Modern acupuncture sells packages. Now I, how do they do this?

You wonder, is it legal? Excuse me. The discount is greater than the cash discount, and the reason why is a package. It is not one visit. So unlike doing a single visit, like what is billed to insurance, you're billing multiple. So think of it, excuse me, the company Target. Have you been in there recently?

When you first walk in, do you notice. There's a little 99 cents store there. Now, why did Target do that? People like the 99 cents store, so that doesn't mean, pardon. That does not mean that you cannot still buy expensive things at Target, but it means they've also realized people like the 99 cents store, so they've adapted a little bit to satisfy that.

You can go in there and still buy a thousand dollars of other stuff. But by fi, but by a few 99 cents Store items. My apologies. I've been a little sick recently. Maybe I should get to an acupuncturist. Nonetheless. Think of modern acupuncture. Why are we allowing them to do that model without us maybe adapting it a little bit?

Why are they the only ones? And I will tell you pretty much in any state, You can offer what they do, which is a prepay. So your practice to continue to grow has gotta get access to people. And this is popular. How does modern acupuncture work? They don't sell single visits. I'll take that back. They do.

You can buy one visit, but it's very expensive. If you buy multiple visits, it's a lot cheaper. If you buy multiples, they can be as cheap as $20, but what it means is you buy them all at once. So here might be something you can offer someone. You have a cash patient who maybe your visit is 75 or a hundred dollars, and for them to come in three times a week, they're like, Ooh, I don't think I can afford that.

So you might say hey, you're gonna need 12 visits to really clear this up. If you buy all 12 upfront, we'll give you those visits for 500. In other words, you're selling it as a package. Let's say your visits are normally a hundred, but if they buy a package of 10, you sell them for 700, so they get a substantial amount off.

That's exactly how this model works. I think it's a way to think of another way to get a person access to care. Think of how people purchase cars. No one pretty much buys a new car for cash. And I'm not saying that never happens, but the majority of us put a down payment, make payments. Notice when they advertise the car, they don't say the price.

No one's gonna say it's 75,000. They're gonna tell you, oh, 2 99 a month. That's affordable. So you wanna put this in chunks. I think this model is something every acupuncture should offer. It doesn't mean it's for every patient. But I think there are gonna be many that'll say, you know what? I know I need the visits.

If I prepay it, I save a little money. It also makes the patient more beholden to care, cuz they've already bought the visit. So how do we make this legal to do this? A couple of things. It has to be a fee for service. If you're gonna do a pre-pay plan, it cannot be for a thousand dollars come as much as you want.

It has to be for a thousand dollars. You get 20 visits. So there's a set number because there must be a refund policy towards it. In other words, any unused funds or visits the patient get refunded. So if a patient says, Hey, I came in for, only five visits of the 10, they would give half of their money refunded.

No big deal. I would also be careful of putting a hard expiration. There should be an expiration, but meaning if there is an expiration, And they expires. You'd have to refund it. So I would just up it. In other words, you're trying to put a person into a plan here would be my point. What if you could sell 10 of these a month for a thousand dollars or 500?

Would that be value? I think so. Realize it's not for a patient using insurance, it's for someone paying cash, but it's another way of giving a discount beyond your regular 10 or 15%. That allows the patient to be better committed because you're gonna tell them, look, you really are gonna need 10 visits to get rid of this problem.

But we know how most of us would work. If I feel better after two or three visits. I'm like I feel good enough. I don't want to keep going, but if I buy the package, so here's a couple of examples of states that have rules about it. Here's one for Maryland, and it says from the board you can offer a prepaid plan, but it says, That the practitioner that chooses to offer prepayment plans must carefully explain it.

In other words, make it clear up front. This is what you've purchased. You've bought 10 visits. If you use the visits, great, we're all good. You can buy more, but if you don't use them, there's a refund portion to it. And realize that swings both ways. What if halfway through the patient is unruly? Rude to staff for whatever reasons, and you don't wanna continue their care, you can certainly discontinue it as well.

So I want you to see Maryland allows it. Here's one even for New York. In New York, it says, may a licensed acupuncturist offer a discounted package of treatments and it says, so long as any insurer is not deceived, packages would not be contrary to New York law. Meaning it has nothing to do with insurance cuz it's not a single visit.

Buy a package. Now, could a package be as little as three, four, or five? Sure. Modern acupuncture sells 24 cuz it's always two per month. They'll sell more than that, but that's how they get you going. I like the idea of this. I think it's another way of trying to reduce the barrier of money.

I. For a patient to come into your office, but we wanna do it in such a way that we can't get in trouble later, that they're saying you're acting like an insurance. If you were to sell an unlimited visit for a set amount of money, that's an insurance. It also means if there's unlimited, what if the patient comes every time or every day or another patient only comes once and says, I want my money back.

You're gonna say you bought six months. You only came once. That's on you. It has to be a set fee. Realize some states get fairly strict and so I'm gonna implore you please verify with your state the rules. Now, if you're in the in our network with me, certainly you can contact me, but again, that's net members only.

American Acupuncture Council Insurance Information Network members can contact me and we can talk about your statement. I'll give you a few examples. In Florida, they allow it, but the package can't be more than $1,500. That's the max. And if it's above 500, you have to put the money in a trust account, meaning a separate bank account as they come and pull it out.

That way they know the patient's money is there. Montana also requires an escrow account, and there's no limit. I would say most states don't require that, but just be sure. The key is make sure the patients get what they paid for, get the treatment, and if they don't, they get refunded. I like this idea.

Think of it. Why do people mostly not come? Money is always a big factor. Let's try to reduce that to make people allow to come in to pay in chunks or get a better value or discount. So here's a few things for just basic compliance. Make sure you outline multiple appointments with a patient. I would really try to set a plan.

Don't just make it, come in whenever, set a plan, have a recall system that you know you're contacting the patient, Hey, you're supposed to be in for the visit. Let's make sure you're coming in. Or if they haven't been in a while, That you are allowed to discount services based on the reduced administrative's expenses.

That's the whole point of this. You're discounting it cuz you're not dealing with all the other stuff that goes along with it. And then notice here, the last thing, have a refund clause that states the patient may receive their unused prorated due to them if they wish to cancel. It's not something they're stuck, nor are you.

It would just be refunded. So when it comes to refunds, and these won't happen too often, I have a lot of offices that do these. And I will generally have them tell me, Sam, I don't get too many people ask for a refund. But what? When they do, you know what they do? They just refund it. Don't get caught up in thinking how dare you?

If someone doesn't like the service, they don't like it, refund it. Move on to the patients that do. Bottom line is this, if your usual rate is a hundred dollars and when they buy the prepay, the rate drops to 50. So they get 10 visits for 500. If they wind up using only half the visits, they get half their money back, meaning $250.

It's always prorated. You can't say since you didn't use all the visits, we're gonna up the fee to our normal rate. It's gonna be the discounted rate. The refund should be calculated on the paid rate, not your normal rate. Charging any more than the quoted amount is gonna get you in trouble and patients are would make a complaint.

So long as you've been fair, not an issue. In fact, you'll find patients love these. If someone is unhappy or moving, so be it. I have one particular office and always think of her when I discuss this. She's in California, San Francisco area. She sells packages, and I'm not kidding, that range from as little as 500.

Her most expensive package is 6,000. I kid you not, but she will admittedly tell you, Sam, I don't sell that many $6,000 packages. She goes, I sell maybe two or three a month. I'm like, wow. Can you imagine someone buying a $6,000 package, two or three of those a month? It's pretty good. To me, it's just another way of having a person, getting access to, in a way that can make it affordable.

Remove the barrier of money, or at least something cheaper. Your practice is gonna thrive because you get patients. Patients come in because they need the care, they understand, and then put a value to it. Be careful. You don't wanna overly cheapen it, but again, creating a greater way of access to it, just do it in a way that protects you.

I think this is a great offer. It's not gonna be forever. And someone might say, oh, I don't want it, but there's enough of it out there. Why are modern acupuncture have so many places if it wasn't working? Must be don't be Blockbuster and Sears. Look and go. Why don't I incorporate a little of that? I think that's gonna be a safe.

An easy way for you to enhance your practice. It enhance access for your patients. Even if the doctor claims, Hey, I did extra services, just refund what they didn't use. The American Acupuncture Council is always gonna be your place for help. I do a services I mentioned. That's the network. So if you're a network member with me, don't forget, you can call me.

Zoom me. We work one-on-one. I become your in-house expert. If you're not a member, think about joining. Go to our website, aac info network.com. Take a look at our services, but realize we're always here to help. There's always gonna be a place that we know. We're gonna make sure that you're okay because your success is ours.

Until next time, everyone, thanks so much.