Kats Chiropractic Consultants CHIROpulse

235 Insurance Season is Here

• Michael Perusich

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Welcome to the KC CHIROpulse Podcast.  

This week’s topic:  Be prepared for the 2026 Insurance Season

The KC CHIROpulse Podcast is designed for Chiropractic professionals ready to elevate their practice to new heights.  This week, the show is hosted by Kats Consultants’ coaches Dr Michael Perusich and Marisa Mateja, seasoned experts in Chiropractic business management.  This podcast provides invaluable insights and actionable strategies to help you create a flourishing and sustainable Chiropractic business.

In this episode, we discuss:

  • Why it’s important to be prepared for insurance season
  • Why your patients may have concerns regarding changes to their plans
  • Why it’s crucial for you and your team to be able to provide answers 
  • How downloading the 2026 reimbursement schedules helps you prepare
  • …and so much more…

In each episode of KC CHIROpulse, we delve into crucial aspects of building a successful Chiropractic practice, covering topics such as establishing a strong foundation, adopting a patient-centric approach, mastering marketing techniques, achieving financial fitness, fostering effective team building and leadership, integrating technology and innovation, and navigating common challenges in the field.

Whether you're a seasoned chiropractor or just starting your practice, the KC CHIROpulse Podcast offers a wealth of knowledge and personalized practical advice to help you navigate the intricate world of Chiropractic business. Join us on this journey as we explore proven strategies, share success stories, and connect with industry experts to empower you in your pursuit of building a thriving Chiropractic practice.

Don't miss out on the latest insights and expert guidance. Subscribe now and unlock the secrets to taking your Chiropractic practice to the next level. Your success is our priority at Kats Chiropractic Business Advisors.


DISCLAIMER:  The information presented in this broadcast is for educational purposes only and is not intended to offer legal, investment, accounting, or medical advice, and represents the opinions of the speakers.  Seek the consultation of a professional for advice in those areas. And remember…your results using this information may be different than described.



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KC CHIROpulse Podcast. Helping Chiropractors keep their pulse on success. Thanks for listening.



235 The Insurance Season

Introduction to Insurance Season

[00:00:00] 

Dr. Michael Perusich: Are you ready for insurance season? Hi, and welcome to the KC ChiroPulse Podcast, brought to you by Kats Consultants and sponsored by Chiro Health USA. We are here bringing you cutting edge business strategy for your ChiroPulse practice. This is Marisa Mateja. And I'm Dr. Michael Perusich. We're your host for today, Marisa Insurance season is here.

Marissa Mateja: It's here. The end of the year is always an interesting time to be paying attention to what your patients have going on with their insurance. So a lot of times this time of year, it's open enrollment season, right? So what does that mean to our practice? A lot of people feel like, you know, maybe that really doesn't pertain to our practices, but it really can impact you if you are not planning ahead and you're not paying attention.

Dr. Michael Perusich: That's right, and there really is a lot going on this time of year. You know, you've got Medicare plans being chosen, Medicare Advantage plans being chosen. Mm-hmm. A CA market plans [00:01:00] are. Opening up and being chosen as providers. This is the season when we can choose to be, if we're on Medicare where we can choose to be par or non-par.

Remember, you can't opt out. Yeah. So you don't get that choice, but you can be par or non-par. So there, there really is a lot happening. 

Navigating Open Enrollment

Dr. Michael Perusich: And Mari, let's talk a little bit about why it's so important to be ahead of this. 

Marissa Mateja: Well, one, it can dramatically affect your practice. If you have, let's just say major companies in your area that are now choosing a new plan for their employees, how does that affect your practice?

Are you on that plan or you mad on that plan? Will you lose patients because they feel like, uh, their insurance is not something that you accept? Are you prepared with communication for that? Or are you going to join that plan? Does it fiscally make sense to you to do that? Right. Right. 

Dr. Michael Perusich: And you don't wanna be surprised by these questions when a patient comes in and [00:02:00] says, Hey, we're switching, um, at our work from Blue Cross to United Healthcare.

Yeah. If you don't wanna look like a deer caught in the headlights, you wanna say, Hey, no problem. We're on that plan, or No problem. Here's why we're not on that plan, because you're actually gonna save money out of pockets by us not being a provider. Let me show you how. Yeah, 

Marissa Mateja: I, I think you just, you wanna be 

Dr. Michael Perusich: proactive.

Marissa Mateja: Yeah. 

Dr. Michael Perusich: Yeah, 

Marissa Mateja: absolutely. So this time of year is a great time to start asking patients when they're coming in, Hey, are you gonna have any insurance changes come January one? Give your your practice time to make those changes, or at least have conversations ready. You know, we wanna make sure that people understand how that may affect them, because we all know.

Patients don't understand their insurance. Right. They really don't understand it when they make changes and they have a new plan. So especially, oh yeah, 

Dr. Michael Perusich: it's a brand new day. 

Marissa Mateja: You know, especially if it's coming from an employer and they're not having the plans put in front of 'em where they [00:03:00] can truly, really go through in depth what's happening.

They get an overview, typically of what it looks like, you know, they may change to an HSA. Plan, do you accept those cards in your office? You know, all of these little things can really affect your practice if you're not ready. 

Dr. Michael Perusich: Exactly. So we need to take a quick break, hear a word from our sponsors, but we're talking about insurance season being here and how this is important and how it affects your practice.

So we'll be right back.

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Dr. Michael Perusich: We are back. 

Administrative Preparations

Dr. Michael Perusich: This is the KC ChiroPulse podcast, and we're talking about insurance season being upon us and how that's going to affect your practice. We've talked about some good stuff so far, how we've gotta be ready and proactive when patients come in and. Wanna know if we're on their new plan or what kind of changes are happening to my plan.

So the other thing that follows with this is we need to be prepared to do verifications. We need to be prepared to [00:05:00] look at, review and download new medical policies for all these insurance companies and things if they're available So far. 

Marissa Mateja: Yeah, there's definitely an administrative side to all of this.

Making sure that we're prepared, making sure we know. What changes the new plans may have? Do they require prior authorization? Do they have the same coverages? Um, are there limitations on the plan? Of course, all of these things factor into how it's going to affect how you collect from patients how you're going to bill.

You may have completely different codes or modifiers that this new plan requires. So lots of little things that could trip you up or slow down your billing process. And your. Of course return from billing process. That's the getting paid part, so you know it, it can affect those things. So making sure that you kind of know prior to January one.

Again, it's all being proactive and being prepared for what's coming and not letting these things affect you. After [00:06:00] January one where maybe you send claims in, you get denials back, oops, that person actually had new insurance and I didn't get that from them. Now we're two weeks. Two to three weeks down the road.

Now we've gotta get the new insurance. Now we've gotta rebuild. Now we've got, the process can really be delayed if we're not careful. 

Dr. Michael Perusich: Yeah, it can, and of course we don't want delays. We want to be able to get paid on time and, and so forth. And we, we don't wanna upset patients because. We don't know the answers to the questions of what does my insurance cover?

And let's say, let's say we don't know and we submit billing and it comes back in an unexpected way where a lot of things weren't covered and they went to patient responsibility. Now I'm gonna tell you, most patients are fine paying for things that may be their responsibility if they know about it upfront.

Marissa Mateja: Yeah, it's that transparency. 

Dr. Michael Perusich: It's the transparency thing. Exactly. And so if we can't look like we're being transparent, then the insurance company [00:07:00] has a, a great scheme to make us look like the bad guy. It's called the EOB. And when the EOB comes back, the EOB looks like the insurance company's on the patient side.

Patient comes in, dragging that going. Explain this to me. Why do I owe more than you told me I did. 

Marissa Mateja: Yeah. 

Dr. Michael Perusich: And it, it just creates a wedge between you and the patient and we never wanna do that when possible. 

Marissa Mateja: Yeah. And I, I think one, it's just good customer service, right? Absolutely. To take care of patients.

Absolutely. To verify and make sure and encourage them to verify as well. I, I, I still think that's a huge pro part of the process is making sure that patients are involved in their care and their coverages so that they understand, uh. What's gonna happen. So if you're the only one verifying that, they can only rely on you.

So you all, you become the bad guy if you're not careful. So if you bring them into the process now you all are a part of it. Now everybody knows what's happening you're more on top of it [00:08:00] with them. 

Dr. Michael Perusich: And you know, the other thing that happens this time of year is reimbursement schedules start being posted.

And you know, I, I'm gonna tell you, they're never etched in stone until January comes. And sometimes even then, they're not etched in stone. But you know, you, you do wanna be starting to take a look at those. And so this is a good time of year to do an insurance reimbursement analysis. Mm-hmm. What does that mean?

Well, that means you really sit down and take a look at, is this insurance company paying us in a manner that we can be profitable? Without over utilization and 'cause that gets us in trouble. We don't wanna do that. 

Marissa Mateja: Yeah. 

Dr. Michael Perusich: So we have to really dig in and think, okay. Especially you've been in practice for a while.

Okay. If you're early in practice, maybe you wanna be on every possible insurance plan you can be on. Maybe. Maybe. But if you've been a, yeah. If you've been in practice for a while, it's really important to do this analysis and make sure that you want to be on this plan. Is there a better way? Are they just not covering [00:09:00] anything?

Are deductibles and co-insurance and things are the percentages just too high? Mm-hmm. And patients are gonna be out of pocket a lot of money. You could do better for the patient and you could be more profitable by having a cash plan, like a Chua type plan. 

Marissa Mateja: Yep. 

Dr. Michael Perusich: So this is a really good time to kind of drill down and take a hard look at that.

Marissa Mateja: Yeah. I mean, what we're doing here is forecasting, right? We're just looking ahead to make sure that we are financially stable. I mean, that's the big part of this is making sure. Can we survive on what we're getting paid from the insurance companies? That means are we covering our cost to deliver care?

Are we in that profitability range? And if we're not, those are plans that you should probably take a look at and really see how many patients are on those plans. You know, if you have just a few patients, maybe time to consider maybe removing that from your practice and [00:10:00] moving them over to like Dr.

Per said a couple.

Dr. Michael Perusich: Yeah, I gave, I remember a funny story. You came to me one time long time ago, and. You had done an insurance reimbursement analysis at the end of the year and you said, Hey, this particular insurance company's only gonna be paying us. I don't remember exactly. It was like $9 or something and cutting us on everything that we submit and you looked at me and said, do we still wanna be on this plan?

I'm like, why are we on it anyway? 

Marissa Mateja: Yeah. 

Dr. Michael Perusich: You know, so you've really gotta take a look at some of those things. 'cause some of these insurance companies have gotten to the point and it's not gonna get any better where they're cutting us so bad, they're bundling us, they're reducing our services. They're, they're putting things to write off and not even to patient responsibility.

So we can't collect from the patient and they really kind of have your hands tied. Yeah. And so when it comes to a profitability factor, some of these insurance companies just don't make sense to be on anymore. [00:11:00] 

Marissa Mateja: And I think you have to analyze that this time of year and figure that out because there are processes in place with those companies to actually remove yourself from those plans.

And some of them are several months. So make sure that if you are looking to remove yourself, that you're, you're giving yourself ample time and knowing when that impact to the practice will end, or how long you have to stay on that plan and those kind of things once you've given your notice. 

Sure.

Good. Good point. We need to take another quick break. We're talking about insurance season being upon us. Marisa, when we come back, I want to, I want to revisit the, uh, medical policy idea, so we'll be right back. Stay tuned.

Kat's ChiroPulse Consultants, your partner in ChiroPulse Success. We are dedicated with one-on-one guidance to bring you all your practice management needs. Let's supercharge your [00:12:00] practice. Give us a call today.

Marissa Mateja: We are back. 

Medical Policies and Reimbursement

Marissa Mateja: We're talking about the insurance season being upon us and I, I said before the break that I wanna talk a little bit about the medical policies. And we kind of touched on this a little bit, but I see this as a big place where so many practices are skipping the step or don't even know about this, and I know Marisa, you can speak to this, but these medical policies are like gold when it comes to dealing with insurance companies.

Yeah, so every insurance company out there has a policy on any kind of coverage that they have. So this isn't just ChiroPulse, but it's any coverage that they offer. So they basically outline and give you kind of their expectations, I'll say, of what they expect from you as the provider. Um, what kind of coverages they have under there, whether they cover wellness or not.

Of course, most of them are. A no on that. A no. Yeah. But they, they typically write that [00:13:00] out in writing on these policies. So if you are on a plan, my recommendation is always. Print and laminate, keep it up front and have that handy that you could pull out and actually have to show patients this is what the company does.

In general. This is how they cover ChiroPulse care. This is what your plan looks like. And then you can have their printed information from the website or the information that you gathered from hopefully a, uh, contact that you've made with the insurance company to get really good, detailed information.

You know, and then you couple those together. I recommend keeping those upfront and, and just having those policies on hand. It is just really important. But some of them go even as deep as giving you what kind of conditions they expect from you, what kind of services they expect from you. I mean, there's some.

Some of these plans out there have some very detailed policies, so 

Dr. Michael Perusich: sometimes they even tell you how to document. 

Marissa Mateja: [00:14:00] Exactly. It's just amazing. Now some of them do not I'll. Yeah, they're not all the same. They're not all the same, but some of them are incredibly detailed. So if you are on a plan, go read those.

Have, yeah, have your staff read those and print those off and have those handy. It just helps with transparency. Again, we're always looking for how do we have a good communication with patients, and b, build trust with them. And that's a great way to do that, is to have those things handy and, and be able to show them exactly where you're getting that information from.

Dr. Michael Perusich: And those policies also tell you when you get the EOB back, what the EOB should look like. And I don't, I don't mean it tells you how to read the EOB, but I, if you go by the policy, if the EOB isn't paying. Per the policy, then the policy gives you the fodder to fight against the insurance company to pay you correctly.

Marissa Mateja: Yeah. 

Dr. Michael Perusich: Yeah. And, and sometimes, sometimes at the beginning of the year as they transition their systems and things with their new codes and, and new policies and so [00:15:00] forth their systems aren't correct and your billing could be off. So the. If you know what the policy is and how they're supposed to be paying, then you can look at those EOBs and know if you are or aren't.

Marissa Mateja: Yeah, exactly. Exactly. Good. 

Dr. Michael Perusich: So insurance season, it is here and it's, it's here. It's importance. So make sure that your. Really on top of things and a couple other things. The knowing what the Medicare deductible is gonna be this year, it's 2 88, is that right? 

Marissa Mateja: I, I, I'll be honest, I don't 8 5 2 88. I look that a couple times and I don't remember.

I'm so sorry off the top of my head, but yeah, it's right in there. It, it is going up and it does every year. So just make sure that you have looked into that, you know exactly what that is because again, that impacts January one, so it. Do the patients that are coming in have the deductible to meet and do they need to pay you out of pocket or do they have a secondary that covers, I mean, knowing that information ahead of time will [00:16:00] help with your collections upfront.

Um, making sure that you don't miss a step or have to send statements and all that after the fact. 

Dr. Michael Perusich: Yep, absolutely. So insurance season is here. Be prepared and, uh, you know, go to Kats consultants.com. These are the kind of things that we are helping doctors keep track of, changes in insurance industry, changes in policy, changes in coding as well as great strategy to be profitable in your practice.

So, Marisa, anything else to add? 

Marissa Mateja: Couple quick steps. Just make sure that you're asking patients if they're gonna have any. Plan changes, um, especially your Medicare patients. Are they gonna go on an advantage plan or are they staying on part B? Ask about employer changes to insurance. Are they offering any new ones?

And ask beyond what the patient is actually getting so you know, for other patients as well. Um, make sure you're verifying, uh, that insurance. So make notes. Verify those benefits come January one, once those are alive and active. And then make sure [00:17:00] that you're educating your staff and training them on some of these details.

So everybody on the team is aware of any changes coming. 

Dr. Michael Perusich: And Marisa, how do you recommend they verify their insurance benefits? 

Marissa Mateja: Well, number one, you can go online, but. Here's the, but most of the time your online benefits don't give you details, so you're not gonna get, do they cover specific codes? A few probably are allowing you to verify some of that now online, but.

Honestly, phone calls are the best. Yes. Are you gonna be on hold? Yes. That's why we have earbuds and different things like that so that we can still maneuver around the office and, and really be able to still work while we're on hold. So don't let that be a factor that you think you're, you're tied to the desk.

Use tools that are available to us nowadays. There's a lot of technology available to allow us, uh, to be still be mobile and still work while we're waiting. 

Dr. Michael Perusich: Where there's a will, [00:18:00] there's a way. 

Marissa Mateja: That's right. 

Dr. Michael Perusich: Awesome. Well, thanks everybody for tuning into the KC ChiroPulse podcast, brought to you by Kats Consultants and sponsored by Chiro Health USA.

We appreciate all of you out there. Please like and subscribe and tell your friends and colleagues about our show. We're growing like crazy and all. It's all because of you guys. So everybody, have a great rest of your week and we will see you soon. 

Marissa Mateja: See ya.