Insurance Update from Dr. Smith

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Insurance Update from Dr. Smith


Greetings Wellness Family!  I was hoping for a more inspirational newsletter/blog to follow by “Inspiration” blog, but I thought this one might be too important to delay, since it may help some of you get more money back from your insurance company.

I am a member of the California Chiropractic Association.  One of the many things they do to support us and the profession, is to take on corruption and abuse by the insurance companies.  I recently received the following email about some recent legal suits that ended in our (and hopefully your) favor.  The insurance companies in the email are Anthem, Blue Cross, and California Workers’ Compensation.  If you have insurance with either of these companies, you may want to look closely at the following article:

Since I don’t work for any of these insurance companies, (although I will work with Workers’ Compenation for any of my existing patients), I am usually unaware if there has been a problem in your reimbursement.   If you feel there has been a mistake or you’ve been taken advantage of as described in the article above, please contact Holly, myself, or the CCA directly.   They amass the many complaints and help get fair settlements and reimbursements.

Just to review, my philosophy in regards to insurance, is that insurance companies are hired by the insured.  As copays and insurance premiums have sky-rocketed over the last decades, it is quite apparent that the insurance company should be working for the patient who is paying with deferred income (“employee benefits”) and additionally, out of pocket premiums, deductibles, co-pays, “Out of network” exclusions and more.  The doctor should be working for the patient as well.  Since doctors began taking payment directly from insurers, the waters became muddied, the doctor began working for the insurance company and treatment rendered became more and more based on what the company would pay for, not necessarily what was best for the patient.  That being said, I believe that it is the doctor’s responsibility to recommend and deliver the appropriate care without financial and time constraints placed on him and her by a for-profit company trying to limit their expenses (your benefits).  This is why I do not work for any insurance company (called “in network” by the companies).   It is our goal at Pismo Beach Family Wellness to help you receive the benefits that you have worked and paid for.  We will continue to do our best to get you your due reimbursements and navigate the insurance maze.  Please let us know if you need any additional help with this challenging industry.

Unfortunately, the systemic pressure to produce ever increasing profit margins, quarter by quarter, puts insurance companies and the people that work for them in a catch 22, where until the system itself is reformed, we will unfortunately pay higher and higher premiums and get less and less covered care, and less and less quality care.

I believe our nation has the resources to provide health care for all of our citizens if it is taken completely out of the for-profit market and paid for by our taxes, as is done in nearly every other highly developed nation on Earth .  According to The Atlantic Daily, our nation is one of the only developed nations without universal health care.  We stand side by side with a few Balkan states and Belarus.  (1)  I also believe that if we taxed the industries responsible for poisoning our health at a rate equal to the true health cost of that poisoning, we would have plenty of money to pay for health care, Junk Food and toxic product would be far more expensive than healthy food and natural products, and people would be healthier and need far less health care.   According to Money magazine, Americans spend more than  $1 TRILLION dollars annually on treating sugar related disease! (2)   According to Forbes magazine, Americans consume 130lbs of sugar per person, each year. (3)  This works out to be about 45 BILLION pounds of sugar consumed by our nation annually.  To pay for the health care cost associated with sugar consumption, a $22 tax would need to be added to each pound of sugar sold in the US.  Since there is approximately 40 grams of sugar in a coke, that would add approximately $2 to the cost of a typical soft drink.   If your soda was purchased from a 12 pack, it would go from 21 cents per can to $2.21 per can.  A 12 oz. Bottle of coconut water would cost about $1.50.  Now, which one is the better buy?

And please consider this… That’s just the extra cost for the sugar!  How much more would we need to add to the cost of that soda if we also factored in the cancers caused by the dyes and preservatives, the brain & neurologic damage caused by the aluminum, the cancers, hormone, inflammatory, and allergic diseases caused by chemical fertilizers, pesticides, and genetically mutated corn used in the soda?  Healthy living would be quite the bargain!

– Troy A. Smith, DC



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