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Doug Landau
Doug Landau
Attorney • (866) 735-1102 Ext 610

Why would a chiropractor refuse to take my health insurance ?

2 comments

A recent case concerning a local chiropractor’s questionable billing practices brings to light some important questions about the use of a chiropractor following an auto accident and, importantly, how those services will be paid for.

Essentially, when a victim of an auto accident seeks chiropractic treatment for his or her injuries, the payment for that treatment can come either from the patient’s individual health insurance or as a part of the auto insurance claim. Which is better for the patient and which is better for the doctor?

Depending on an individual’s health insurance plan, it might be in the patient’s best interest to have their health insurance company cover the chiropractic services. This is particularly true if the patient’s health insurance has no deductible or a very small deductible, meaning that the use of health insurance will keep the patient from having to pay any money out-of-pocket for medical care expenses in the wake of an accident.

Unfortunately however, the financial interests of the auto accident victim and the chiropractor don’t always align so nicely. In some circumstances, from the chiropractor’s perspective, it is more lucrative if payment for services is taken out of the auto insurance claim. This incentive might exist depending on state law and the specific coverage that the patient’s insurance plans offer. Sometimes, in auto accident cases, the amount of medical expenses that normal health insurance will reimburse to the service provider are reduced by a percentage. This means that you, the patient, won’t pay any money, but the service-provider may not receive the full amount from the insurance company. In other words, an injured car crash victim’s health insurance company may pay 60 cents on the dollar for chiropractic care. The Chiropractor may prefer to NOT bill the valid health insurance, but instead put a "lien" on the car crash case by having the patient and/or the patient’s l;awyer signan "Assignment of Proceeds" (like an "IOU") so that they can get paid 100 cents on the dollar a year or two later. However, by definition, this takes money away from the patient’s net recovery where their health insurance would have paid and there was no deductible.

Some chiropractors mislead patients and tell them they will bill their health insurance, and that signing the "Assignment" is "just in case." Still other chiropractors will bill the patient’s OWN car insurance medical payments coverage rather than the valid health insurance in order to get more money, even though the disabled patient might need those limited funds to pay deductibles or for treatment not covered under their insruance plan. And still chiropractic practices fail to bill the health carrier in a timely fashion, leaving the injured patient no alternative but to pay "full freight" or be sued by the chiropractor.

Read in tomorrow’s post how to take control of this situation and ensure that you get billed as you wish.

2 Comments

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    In California insurance companies often want to know if a patient has been in an auto accident and will ask the doctor and the patient. If so and there is a primary insurance, like medpay, they will refuse to pay citing the patients auto insurance as primary.

    In my opinion there is nothing wrong with a doctor getting paid what the treatment is worth. Does your law firm often accept payment at 60 cents on the dollar?

  2. Doug Landau says:
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    Dear Scott:

    It is not always clear if the treatment is from a car accident or pre-existing arthritis, a prior injury, degenerative disc disease or other ailments, so health insurance may be primary even where treatment comes after a car wreck. In Virginia, if a recovery is made in the lawsuit, then the ERISA health insurance is often paid back, but the client is not “out of pocket” on the front end or taken for charges for which they had valid insurance on the back end.

    As for 60 cents on the dollar, the short answer is “yes.” At my former firm, where there were members of a prepaid legal plan (like health insurance) there was negotiated reduced fees up front. The same holds true for people I meet with on behalf of the Fairfax Bar Referral System. Likewise, in cases involving younger individuals, we have never charged a full fee. And, since we are not paid until the end of the case, and our large monetary investments in cases are not reimbursed until the conclusion of the claim, it is an “interest free loan” to the clients that in a number of cases comes out to even less than 60 cents on the dollar.