"TCI" is "That Crappy Insurance." Do you take it?

The ongoing question in all of eye care: “Should I accept (or drop or keep taking) TCI?"  T.C.I. is an acronym for “That Crappy Insurance”; you can insert any of the ones that we consistently discuss here.  The reason we continue to discuss it is that it isn’t clear what will happen if we change. 
 
Here’s what we know:

  1. They don’t pay enough for the services we provide and they often create limitations in what we are able to provide to our patients.
  2. Many of their clients will choose someone else for their eye care if we are not on the list.

Like the little angel on one shoulder and the devil on the other, we argue with ourselves, unsure of the right decision. 
 
I have never heard anyone say, “We dropped TCI and it was the worst thing we ever did.” 
 
In its simplest form, the decision to be in or out of a given network depends on two factors and can be decided with a simple four quadrant grid – also known as a Kapperman Grid.  The two questions are: Does the given insurance pay well or not well? And - Is the practice patient schedule full enough or not full enough?
As illustrated on Table 1, you can see that an insurance that pays poorly in a practice who has a schedule that is full enough lands in Quadrant 1.  The obvious decision is to Drop the Plan.  Whereas a plan that pays well in a practice that needs to fill up its schedule lands squarely in Quadrant 4, making the decision easy to Keep the Plan.  Quadrants 2 and 3 are less clear about the decision.
 
Note that this grid gives you the decision in its simplest form.  There are many other factors to consider in a given community and practice.  These factors may include how many people in the community have TCI or what medical plan is associated with it. 
 
Private Pay patients are not yet a thing of the past, but they are becoming less common.  We must be careful to not let our practices become enslaved by these plans that tighten the reigns more and more every year.  If you find yourself cutting corners so you can take more plans, consider that you may be doing a disservice to the people that are willing to choose you over their plan. 
 
If you do decide to drop a plan, read this idea about how to capture as many of those patients as you can.
 
Thanks,
Mike
 
p.s.  Have you done this lately?  We would love to hear your story…...

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