It’s hard to know where to start on the subject of chiropractic billing for young patients.
Pediatric chiropractic is interpreted and defined differently by chiropractors right across Canada. I called many to speak on this issue and became increasingly interested in getting the question answered. And the reactions to my question were varied to say the least. On the topic of billings, no two doctors seemed to have the same thing to say. There was definitely no set of rules as to how much to charge. According to Dr. John Tucker, Director of Policy Analysis and Communications from the Canadian Chiropractic Association:
“Billings are provincial in nature, dependent on provincial medicare schemes, Workers Compensation, auto insurance, extended health benefits insurance and recommended fee guidelines established by provincial chiropractic associations.”
THE BASICS
The philosophic approaches to chiropractic cover a wide spectrum from scientific-based to wellness- and maintenance-based. Within that spectrum, you also find varying attitudes toward the treatment of children. Decide what you feel comfortable with. Then stick to that decision.
DEFINING “PEDIATRIC”
Technically, anyone under the age of majority requires parental permission to be treated and is considered “pediatric,” according to some of the chiropractors I surveyed. However, the term “pediatric” generally refers to pre-school-aged children, whereas school-aged children are usually categorized as “students” under fee schedules.
CREATING STABILITY AND TRUST
The key to determining fees for pediatric patients is to understand that your chiropractic expertise is of incredible value to patients young or old. Therefore, you should avoid giving free service. It is not the way to build trust and confidence in your patients, as they will surely wonder why you give away your “valuable” services for free. At the least, a nominal fee should be charged for the initial exam and any subsequent treatments so you do not devalue the worth of what you have to offer.
SURVEYING IS KEY
In an archive issue of Canadian Chiropractor, past managing editor Dr. Ian Horseman wrote, “How can two chiropractors practicing in the same area have two completely different fee structures while offering the exact same service? Is one doctor more qualified than the other? Is one chiropractor’s treatment that much better than the others’? The answer is obvious to us as chiropractors, but to a potential patient it creates confusion and even mistrust.” So go ahead, find out what fellow practitioners in your area charge. Do not try to market “cheaper” fees as that just cheapens your service, and the public stays away in droves when perceived value is diminished.
EDUCATION
The key to building an all ages practice is to educate the parent and children. Parents usually need to be enlightened on the benefits of chiropractic care for children. Do not assume they are aware of all the potentials of chiropractic. Most people have no idea of the scope of physical problems that chiropractic can help in children. And of course, there is lifetime wellness to be promoted as well. Having well-written material to give to parents is essential. There is no shortage of articles and patient education materials on the subject of pediatric chiropractic to encourage parents to choose chiropractic care for their children. Children should be given simple talks on the subject of chiropractic, but make sure you adjust your terminology so it communicates clearly to kids. For example, the brain can be equated to a computer and the spine can be likened to a garden hose. Posters in your practice showing families and a “Chiro Kids” wall with photos of your pediatric patients also really helps promote awareness that everyone in the family need chiropractic. Education also means letting your patients know what it takes to be able to give the best professional care. People are much more willing to pay for what they understand to be valuable. And what parent does not want their child pain free, limber, and healthy? Your provincial associations often approve campaigns that you can tap into to raise awareness of the pediatric aspect of your practice. For example, the Ontario Chiropractic Association is currently running an OCA backpack safety campaign you can promote to encourage parents to bring in their children.
SAMPLE FEE STRUCTURES
I hope you will find the following data on pediatric fees collected from various Chiropractors across Canada helpful. This is a microcosmic cross-section and not intended to be anything other than enlightening.
NOTE: The Provincial Insurances delisted Chiropractors after this article was published in Canadian Chiropractor Magazine in 2003.
Nova Scotia (This province does not have provincial coverage)
Chiropractor 1: Newborn to 18-year-old patients are charged $40 for the first visit and $20 for subsequent visits.
Chiropractor 2: Initial visit charge is the same for adults and children.
Ontario (partial coverage)
Chiropractor 1: Charges the same fees for children as for an adults.
Chiropractor 2: Charges $25 to $50 for initial visit, depending on the time spent, and then $5 above provincial coverage for subsequent visits.
Chiropractor 3: For children under the age of seven, a regular visit is $7 plus provincial coverage. If the child’s parent is also a patient, there is no exam fee for the child (but provincial coverage is billed). If parents are not patients charges $75 for the initial visit and $19 for each future visit.
Chiropractor 4: Patients under the age of 6-years-old are charged $30 for an initial visit (compared with $40 for an adult) and $5 for each following visit if their parents are patients. Otherwise, they are charged regular adult fees. He also tells parents that $100 for 20 visits is a pretty inexpensive way to have healthy kids.
Alberta
Chiropractor 1: Patients under 13 are charged $20 for the initial visit and $5 plus provincial health coverage per regular visit.
Chiropractor 2: The initial visit costs $50 for everyone. Regular visits are free for children up to the age of seven if the child’s parent is a patient.
IN SUMMARY
There you have it…I suggest doing your neighborhood survey when determining your pediatric fee structure and work in a spirit of cooperation. It looks good for the chiropractic profession to have some solidarity.
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