“ Box on the Wall ” is a philosophy that some chiropractors use to make sure that finances do not get in the way of patients receiving the treatment they need.
History of “ Box on the Wall ”
Whether called an “Honor Fee” where, “everyone here pays according to their own means,”1 or “ Box on the Wall ” where patients “choose a weekly fee that is fair and within their budget, then drop their payment anonymously into a sealed box,”2 the concept has historical roots in the GPC (God-Patient-Chiropractor) system, founded by Dr. George Shears. “Shears’ thought chiropractic should be [more like] church than…healing art…Shears’ also thought that licensing laws might be circumvented under…freedom of religion.” Times have changed since that original concept. Chiropractors using this system vary, sometimes with regard to the amount of insurance coverage available. Some note that “fee for service” is a medical model, but that chiropractic isn’t a treatment out to cure a condition. Chiropractic is a wellness model, and “Box on the Wall” eliminates that medical mindset. Others use a “cooperative” approach, such as one proposed by Reggie Gold: “if the chiropractor was going to make the commitment to give the patient care with no assurance of reward, then the patient… had to cooperate by following certain requirements laid down by the doctor,” or pay a published fee. Still other chiropractors use insurance for acute treatment and “Box on the Wall” for maintenance treatment not covered by insurance.3
One Chiropractor’s Perspective
There are chiropractors who feel a moral or ethical responsibility to provide care to patients without worrying about cost or insurance limitations. One chiropractor, Dr. Eric Carson, a board certified Doctor of Chiropractic in Illinois, spoke recently about his desire to one day move to the “Box on the Wall” method of payment. Dr. Carson wants to help patients get the care they need, and avoid surgeries later. “My ‘Box on the Wall’ philosophy stems from just wanting to help others achieve better health without the restraint of cost.” He doesn’t want money to stop patients from getting their therapy or achieving better health. He added, “We are not designed to be in pain, and when I think I can help someone, I don’t want anything getting in the way of that.” He is also frustrated with some of the “insurance roadblocks”, such as having to get preapproval before treating someone. Dr. Carson believes that some insurance rules get in the way of patients getting immediate relief: “Patients should not have to wait days for help.” He isn’t necessarily going to wean off of insurance; some insurances, such as Medicaid, can be helpful to some patients who “need a helping hand”. Besides the patients, he is concerned with “thinking of the staff”, because their time needs to be compensated, and he doesn’t want to have layoffs or affect any raises or bonuses. For now, it is easier to work costs out with patients for things that are already paid for (such as equipment). Dr. Carson already employs a method of working with patients about costs up-front, or in case a patient’s insurance/finances change. It would be a future goal of his to have a box in every exam room, and not knowing what each individual client pays. “That way, you treat everyone the same,” he noted. The anonymous box would be a strong possibility, at least in the last 2 years of his practice, before retirement. Dr. Carson said, “Financial stability would be a necessity, first, so as not to jeopardize employees.”4