Regarding Prepaid Packages

A patient told me she was 'convinced' to buy a 100 session prepaid chiropractic package that she had to use within 6 months to 'maintain' her neck and back health after she went for a free trial. 

A chiropractic clinic offered a free trial session at a roadshow in a mall and she went to try. She had appointments to go 3 times a week, which is terrible for a working adult's schedule. To add salt to injury, each appointment lasted less than 5 minutes. 

You may have heard similar horror stories or even experienced them personally. Not just chiropractors, it can also be the beauty therapist pointing out all you flaws while offering you a limited time promotion to treat them while you were in a vulnerable position. 

Actually, the beauty industry received 1454 complaints last year, accounting for about 10 percent of all complaints that the Consumers Association Of Singapore (CASE) received.

My wife was in a similar position too previously. She had gone for a massage and while lying face down was asked to add essential oils and buy a package. She felt trapped in the room until she agreed to buy more sessions.

Prepaid packages often happen in pressure sales tactics where you are told that your crooked back, posture, freckles etc can lead to paralysis or something worse if left untreated. Often they prey on your fears to ensure that they can hang on to you, hoping that they will not lose you to another competitor. You are then locked in as all the money is paid upfront.

There are physiotherapy clinics that sell packages too, despite the Ministry of Health saying physiotherapists cannot do so. Perhaps these clinics pay kickbacks to rouge agents and doctors to refer them patients so they practice such tactics. MOH investigated physiotherapists, doctors, insurance agents and others after a physiotherapy clinic in Camden Medical Centre went bust for inflating insurance claims by selling packages.

As a business owner, I can understand that this helps to protect the businesses that sell them. Running a physiotherapy clinic (or beauty salon) requires significant capital, which includes staff, rent and equipment as part of overhead costs. When patients/ clients buy a package, it helps to allay these costs quickly, especially for a new clinic.

Selling a package does not work in our clinic. For instance, if I treated 5 new patients a day and each of them buys a package of say, 10 sessions. I would owe them 9 sessions after their first session, but I would soon run out of appointment slots to see them if all new patients buy a package. 

It will only work if the patient sees another colleague or each session is less than 5 minutes. In our clinics, initial sessions are 60 minutes long and follow up sessions 30 minutes if needed.

Actually we try to make our patients well as soon as possible instead of hanging on to them. We prefer that they get pain free and be happy patients so that they refer their families and friends to us. 

As patients (or customers), please do not be afraid to say no if you are asked to buy a package. If a promotion sounds too good to be true, it probably is. These salespeople/ healthcare professionals will try hard selling tactics, often by preying on your fears. However, you have the right to decline any offer that does not align with your needs or if you are not ready to make a decision. Stick to your decision firmly and politely.

Remember under the Allied Health Professions Council which registers physiotherapists in Singapore, does not allow physiotherapists to sell packages. You can definitely visit a clinic that does not offer any packages so you do not have to worry about committing to any large upfront payment.

$677 For A Session Of Acupuncture Or Physiotherapy!!

Posed picture 

Recently I had a patient who rang me up saying he had right shoulder pain and he wanted to go for a MRI scan to rule out anything sinister. He asked if I can recommend him a doctor to hospitalize him and then do whatever necessary tests that was required. I told him that for a MRI he need not be warded. Then he said that if he was not warded he would have to pay for the investigations in full .....

I had to politely decline as I thought it wasn't right to make insurance pay for the scan if a patient does not want to foot the bill.

So I'm not surprised to read that there are mercenary physiotherapists, chiropractors etc who take advantage of the insurance system to bill excessively.

In New Jersey, school employees are covered by the state's School Employees' Health Benefits Program. This plan covering school teachers covers virtually anything the "out-of-network" providers charge.

In 2018, the teachers' plan paid out an average of more than USD $600 per visit to an acupuncturist or physiotherapist! This is even higher than out-of-network fees of psychiatrists and gynecologists.

As a result, more than 70 acupuncturists and physiotherapists earned more than USD $200,000 in 2018 from their teacher clients alone. Data also showed that one acupuncturist earned more than USD $1 million dollars!!

To further sweeten the deal, some of these providers are suspected of waiving a co payment by the teachers so there is no out of own pocket payment by the teachers.

The same state fund paid out USD $11.2 million dollars to a clinic -Thompson Healthcare and Sports Medicine for providing chiropractic services, acupuncture and physiotherapy to teachers.

Thompson Healthcare and Sports Med during a school visit

Investigations by the state showed that these payments consumed hundreds of millions of dollars in the last four years. This has possibly affected all residents in New Jersey as homeowners in towns where the schools are located are all paying higher property taxes.

Six people (half are union members) make up the state panel overseeing the benefit plan have not done anything to stop the runaway costs. This is despite meeting transcripts showing discussions regarding this since 2014.

All these data and documents, along with interviews with state officials show this is what happens when savvy (and mercenary) health care practitioners find lucrative loopholes in a loosely designed employee health plan.

As expected, the teachers' premiums have increased by 8 and 13 percent in the last two years. The most popular family premium plan cost in excess of $36,000 a year. This is nearly twice the cost in other parts of the country.

I dare say that if the teachers realized the exploitation of the plan, they will definitely think twice about how they use their health care benefits.

Back in in Singapore, there was an article in the Today online paper regarding some physiotherapists in private practices paying doctors and surgeons kickbacks to get patients referred to them.

You can also read our other blog, where we have previously written about these kickbacks in our Singapore healthcare system too. Needless to say, private medical clinics and MRI / X-ray companies  in Singapore are implicated as well.

It is bad practices like this that will lead to increases in our health care visits, insurance premiums and Medisave-approved Integrated shield plans.

You can read the read I referenced here.