Despite the promises of the Affordable Care Act, here’s the stark reality: there has been no documented rise in new patients or visits for chiropractors; but there has been a decrease in reimbursements and increase in the number of “narrow networks” that we are dealing with.

Yes, I understand that President Obama publicly promised that patients could keep their current doctors upon the launch of the Affordable Care Act. Admittedly, there is some debate as to whether this statement has come true.

Politics aside, even IF patients could keep their doctors in the Obamacare plans, the fact remains that the doctors may not want to keep them. There’s nothing against the patients here. The reality is that the insurance plans have changed so rapidly that some are becoming increasingly undesirable to work with.

This situation is becoming so commonplace that healthcare experts have termed this trend the rise of the “Narrow Network”

What the Narrow Network Means For Chiropractors

Essentially what we are talking about here are insurance plans with surprisingly little to no coverage for chiropractic services. There benefits are slim as are the number of providers on the plan – thus, the name “Narrow Network.”

And unfortunately, these plans are springing up everywhere are health insurers scramble for new ways to grow their profits in the midst of Obamacare. Take for example, Washington State, where the two major BCBS payers have not only switched plans, migrated names and added all sorts of hoops to jump through via their outsourced management third-party administrators. Doctor’s, their staff and patients are left scratching their heads and trying to make sense of benefits that they thought were covered (because yesterday they were). But today is a new day, with new plans and new insurance cards.

Technically, most of these plans meet the Affordable Care Act requirements (although there is some debate and some lawsuits emerging on that issue) but the benefits are mighty slim.

This problem could be easily avoided if (a) the patients understood what they were signing up for and (b) if there were a plethora of “wide network” plans available.

But according to research compiled by the McKinsey Center for U.S. Health System Reform report, the number of broad networks shrunk from 51% to 30% of the market while the number of narrow networks increased from 15% to 35% in just one year (2013 to 2014). Similarly, “ultra-narrow” networks (whose benefits and provider base are even slimmer than the narrow network) also increased from 11% to 30% during this time period.

The Writing On the Wall

The trends are clear. Employers (and some consumers as well) are more frequently choosing narrow networks because the premiums are cheaper than the traditionally based “wide network” counterparts.

This means patients have less coverage and there are fewer doctors to serve them. Of course, this translates in to bigger profits for the insurance company.

What Chiropractors Can Do

Gone are the days where chiropractors can blindly sign up for every insurance plan that will have them. On the contrary, there are some insurance plans that we definitely need to avoid because they are not worth the time and the trouble.

But apart from surveying your colleagues (not a horrible idea, but time consuming and highly subjective), what can you do to ensure that the payers you are dealing with are the ones that you want to be dealing with? Here are a few recommendations:

Keep the Big Fish: In most locations, the insurance landscape is dominated by one or two larger payers. If you break that down further, you will find that there are several large employer groups that are the biggest players in that market and those employers are insured by one of these big payers. Unless you like swimming upstream, keep doing business with those payers.

Throw the Little Fish Back: Similarly, there are also a handful of small players that typically only serve to provide an annoyance to you and your staff, but don’t really provide you with many (or any) patients. Get off those networks. With the fast pace that networks merge, create new names and new alliances, you don’t want to suddenly find yourself stuck in a new (and perhaps even lousier) network based on your association with an already proven loser.

Watch Out for The Line Tanglers: Then there are some payers that just create an enormous amount of hassle for you and your team. If we keep the fishing analogy, they tangle your line to the degree that you rarely end up catching your fish. Instead, you end up cutting your line. Do the same with payers who have too many rules or requirements, request additional documentation all the time and generally make your life miserable.

The Strategy Behind These Solutions

If the trends continue, we will see an emergence of payers whose benefits are nearly non-existent despite that fact that it will take you a while to figure that out thanks to their lack of transparency. (Haven’t yet seen a plan named a “narrow network” or better yet, the “Dirt Plan” or something similar. Instead, they have creative sounding names that reveal next to nothing like but resemble hotels or constellations or some other unrelated symbols such as: the Nova plan or the Phoenician or Mark IX.

And so, as you continue to do business with these folks (as an in-network provider) you will continue to forfeit your benefits and your rights to collect for what you do.

Note: I’m not saying don’t take insurance.

I’m saying that you need to strategically consider that plans that you participate with and make sure that they are worth your time and effort. In that respect, it’s a numbers game. And you want to ensure that the numbers have the ability to work out in your favor so that you can get paid for the good work that you do.

It’s a simple concept, but it’s unfortunately becoming more difficult to execute.