How We Got Here - The Quagmire of Health Insurance Billing

Introduction

When I founded DMR Move in a community already saturated with over 70 traditional rehabilitation clinics, it was not to be just another name on the list. Rather, it was an extension of my own values, aimed at inspiring hope and promoting growth within the community. I had no desire to merely add to the existing healthcare landscape but sought to fill the gaps left by traditional systems. My vision was profoundly shaped by my personal struggles with chronic pain and the deficiencies I had encountered in conventional healthcare. While there are others on a similar journey to improve care, over the years, collaborations around the world and research on standard healthcare practice have shown me that these shortcomings are not limited to my local community; they are a global issue. With this broader understanding, I committed to creating not just another clinic, but a sanctuary. My objective was to offer a comprehensive new approach to complex human health problems—an approach grounded in person-centered care, reinforced by scientific rigor, and meeting world-class standards. I wanted to establish a sanctuary that not only served as a refuge but also restored hope and dignity to those who have been marginalized. Where the skills our clients gain don’t just address the issues that brought them to our door; they also prepare them for future challenges and struggles in all aspects of their lives. With the hope we could not just impact that person, but their family, their friends, and the communities around them.


Now, nearly five years in and supported by an extraordinary team, we’ve turned that vision into a reality. Every day, we see our clients reclaim their lives. They don’t just find solutions to their immediate problems; they learn comprehensive skills that they can apply to other areas of their lives. We hear incredible stories about how these newfound abilities have ripple effects, even to the extent of parents passing these skills on to their children. Words cannot fully capture how proud I am of what we’ve achieved.


Unfortunately, a crisis has arisen from factors outside our control that threatens to undo all our achievements. Despite continued growth and increased community awareness, we are in a financial crisis as a result of catastrophic neglect and errors from our external insurance company.

 

Navigating the Perils of Insurance Billing

When DMR Move was founded, we could have taken the easier path of operating as a cash-only facility. However, we knew that this approach would inherently limit access to our services for those who could not financially afford cash-based services, even with sliding scales. Committed to broadening healthcare access, we decided to accept all forms of insurance, including Medicaid. This choice, while fostering inclusivity, also introduced financial and administrative challenges. To complicate matters, we didn’t just stop at Medicaid; we also took on other types of insurance, such as auto and workers’ compensation, which come with their own sets of hurdles. 

 

The Decision to Outsource: A Double-Edged Sword

Faced with the complexities of insurance billing, we had to decide whether to keep this task in-house or outsource it. In-house billing would have demanded a disproportionate amount of time and resources, a commitment we could not afford at the time. To outsource meant the billers received a percentage of our billing and we had to trust this was enough to incentivize them to stay on top of the time-sensitive billing process. With limited resources and a commitment toward increased access, we had little choice to but to pivot toward outsourcing, a decision that, in hindsight, set a trap that many private practice owners don’t see coming.

 

The Outsourcing Trap

Initially, outsourcing seemed to be a practical way to manage costs. We went through a series of external billing services, each presenting their own set of challenges, subpar performances, and unfortunately also hundreds of thousands in lost reimbursements. After two years, we settled on a large national company, believing they could address the shortcomings of the previous external billers. For nearly three years, they managed to provide us a fair service that was better than our previous billers but still required constant oversight. At the same time, we noticed that they prioritized bigger clients and clients who did not take Medicaid or auto insurance since that also meant lower reimbursement and delayed payment for them. But all this deteriorated catastrophically in April 2023 when they began completely neglecting our account, in addition to making errors, leading to a financial crisis that did not become evident until June. After three months, which included turnover involving four different account managers, very little improvement in billing practices, and the denial of access to our own accounts, the full impact of being trapped in external billing became apparent.


A Financial Crisis at the Worst Possible Time

We find ourselves in a predicament: the only viable option is to bring billing in-house. Since we cannot afford a biller due to the number of resources and finances we utilized up to this point, we plan to distribute the billing tasks across multiple members of our amazing team. This task is further challenged by our depleted financial reserves and erratic cash flow, the latter being a direct result of errors and neglect by our soon-to-be-former billing agency. These reserves were already compromised by the direct and lingering impacts of COVID. We also never received the full recovery funds to which we were entitled, compared to other businesses of equal size, further exacerbating our financial strain. We also had to factor in the lost reimbursements from our previous biller’s errors.  Obtaining a loan was out of the question; banks are hesitant to back healthcare in generally, let alone a healthcare entity with an active cash flow issue outside our control, even one with our community impact and track record. We have also exhausted the financial support that was available from friends and family.

 

The Final Resort: Crowdfunding for Survival

Our last viable option is a crowdfunding campaign in order to get enough financial resources to be able to survive our transition to in-house billing. It’s a desperate step, but one that we must take if we are to keep our doors open and continue to serve the community that so desperately needs us. We are confident that with just enough to bridge this transitional gap we will bounce back, but we need your help to do so!


In Closing
As we face challenges that threaten DMR Move’s mission, we’re launching a crowdfunding campaign as both a call for financial aid and an invitation to reshape healthcare. Your contribution serves as a vital lifeline, enabling us to continue offering transformative care. In navigating these difficult times, we believe that we can emerge stronger with your support. Once we recover financially, we are committed to giving back. A portion of our profits will be progressively donated to the Institute of Contextual Health (IOCH), up to and exceeding the amount we received from this fundraiser. The IOCH focuses on advancing individualized healthcare frameworks and aiding underserved communities affected by chronic pain and complex movement disorders. Your support doesn’t just help us; it contributes to a larger cause. 

Thank you for considering a role in this vital effort.


Keep Hope Alive: Your Support Today, Our Gift Tomorrow by DMR Move (fundrazr.com)

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