07/25/2022
SOAPBOX TIME: What's bad about Treatment Contracts?
--First, they're not necessary. Projecting an expectation of care and costs is fine and I do that too. Experience should forecast possible needs and costs. Fine. That's simply forecasting care and does not require a "plan", like a gym membership.
Selling a patient a calendar-based contract serves no real purpose except for the doctor to forecast his income and like any installment plan, hope you don't cancel early. There are some exceptions but generally, health care is based on a "fee for service" expectation. Inducements to treat are actually often illegal and a contract infers that a schedule, rather than medical necessity, may be leading to extra fees to an insurance carrier.
HERE are the main bad points of most contracts whether under insurance or private pay:
1. It establishes the idea that a calendar will manage your number of visits and treatment procedures rather than the evidence-based reality of your body's recovery.
2. Most contracts put patients on a 3-2-1 plan: 3 weekly visits for X months, 2 X, then 1 X and often this is projected out for 6 or more months in advance. It is rarely a good idea to commit long-term money for a short-term problem, as most back injuries are.
3. Often to encourage compliance with a long, expensive plan, the office will offer you an incentive, like "15% off the cost if you commit today!". Like opening an account to get the hook-- a toaster oven, or some other illusion of an advantage if you put the costs on an auto-charge credit card. Don't fall for it!
4. These plans often prey on a hurting patient when they are most acute and vulnerable as if the crystal ball of the doctor is doing them a favor for the 6-month projected future. Actually, most back problems will get better in a much shorter time frame, and if not, referral should be considered instead of finishing some prescribed series of rote treatments.
5. Often treatment plans are accompanied by "lecture night", or you're expected to bring a friend or family member for a group report of findings. These practice-building ploys are trolling for patients like a time-share salesman.
6. Planning with goals and benchmarks does not require a calendar. Each visit should see progress and the number of visits is irrelevant. Progress is complex and calendar programs subtly train the patient to think they can't trust their own experience.
7. Getting out of a plan is sometimes hard. Be prepared to get harassed if the clinic is considering you more of an "installment plan" than a patient they should serve with only YOUR best interest as the goal.
Are monthly contracts EVER a good idea? Rarely. If one has no insurance, a family plan, on a per-need basis, is fair but even that should not require auto-payment unless you need and have received the treatment. Discounting a fee for true financial hardship or even pro-bono care is allowed, but that does not require a "contract". That is instead a payment arrangement that is based on need and remains a "fee-for-service" payment. Be careful. If you feel you're hearing a sales pitch, walk away.
