Serving Chiropractors and Their Patients

Archive for the Insurance Category

How to Obtain and Prioritize the Use of a Patient’s Medical Pay Coverage

Chiropractors are often faced with the situation where they are treating a patient who has medical payments coverage under an automobile policy, or similar “personal injury coverage protection” (Often referred to as “PIP”)  During the course of care, either the patient or their attorney will occasionally request that the Doctor bill an insurer other than the medical pay provider.  As a consequence of such a request, the reimbursement rate is frequently unavailable or lower under another form of insurance coverage.   A contributor at this website, David Michel of Petty, Michel, and  Associates, a leading chiropractic consulting group, recently provided insightful information on how to address this situation involving “medical pay”coverage.  Those comments are stated below:

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Letter of Protection … Or Else

Doctors are increasingly facing situations where either the patient or their legal counsel is delaying or deliberately avoiding payment for ongoing treatment charges. This often occurs when the patient is receiving extended care and insurance benefits have been exhausted or their attorney diverts medical payment benefits of an automobile policy to other parties besides the treating chiropractor. (A Blog on this type of action by attorneys was previously presented on March 19, 2013) In these type of situations, there is one reliable option available to the doctor which should be considered to insure future payment for services.

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Class Action Decision from Larson Affects Co-Pays

Chiropractic treatment is a common healthcare service that years ago was not routinely covered in health-insurance policies. For more than 27 years, however, Wisconsin has required health insurers operating within the state to cover chiropractic care on an equal basis as other forms of medical care for the same condition.

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Recent WI Court Decision Addresses Medicare Claims Submission

A Court decision was recently rendered in Wisconsin which addresses the intracacies of claims submission to medicare in situations involving treatment of patients involved in “tort” or negligence cases where there is a third party- insurer  available to pay for treatment expenses.  That third party can commonly be a workers compensation insurer of the patient’s employer or liablity insurer of  a negligent driver involved in an accident with the doctor’s patient. In the case of Conrad Laska v. General Casualty Company, the Wisconsin Appellate court noted several important medicare reimbursment concepts in these types of situations.  In this case, a hospital filed a statutory lien against a tort or third party payor seeking payment out of any eventual settlement or jury verdict, rather than billing medicare for an injured parties treatment.  The Court reviewed several medicare reimbursement concepts in its decision which are worthy of consideration by the chiropractor treating patients involved in these situations. First, the Court reviewed the “Provider Agreement Statute” (42 USC 1395cc-Special “legal speak” for the United States Code)  Under this statute, a provider participating in the medicare program “may not charge any individual or any person for…services for which such individual is entitled to payment under

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Preserve Medical Payments For the Treating Chiropractor

Chiropractors have contacted our office lately with concerns relating to their ability to receive payments under a patient’s medical pay coverage of an automobile insurance policy.  As most doctors are aware, many automobile policies contain “med pay” provisions which provide coverage for the health care treatment provided to an insured  under the policy.  The insurerd commonly includes any passengers in an automobile involved in an accident.  Treating chiropractors should always question a patient to determine if this type is coverage is available since the limits of the med pay is typically paid without the types of challenges or discounts often made  to coverage proveded by a health insurer. Some doctors have noticed recently that attorneys representing patients have unilaterally  “invaded” the payment process by either advising the med pay insurer to pay the patient/attorney the limits of coverage or redirect all payments to a provider other than the chiropractor.  Although payments are usually made to whichever proviider first provides the care and submits a claim, many policies have been interpreted by attorneys as allowing the patient to  control and manage the amount of coverage available to them.  There have even been situations where the attorney has expressly told the insurer not

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