Guest guest Posted May 18, 2004 Report Share Posted May 18, 2004 Williard. . . you spoke (typed) incorrectly. (Quote " I do not think that $150 is an excessive charge for an adjustment -- now, you apparently do. " End quote) If you look in my original post, I clearly stated that a chiropractor should be able to " justify " why he charges 3 times what other DC's in his (or her) area charges. Skill, con't education, etc., etc. would help in justifying this fee. I believe that the majority of people charging excessive fees do not have a large cash practice that is willing to pay $150 for an adjustment. I may be wrong, I'd like to see some statistics. Thanks for the illustration of Yellowstone National Park, I didn't quite follow your reasoning, however I would like to vacation there sometime soon. J. Vissers, DC Original Message: ----------------- From: Dr. Willard Bertrand mail@... Date: Tue, 18 May 2004 16:40:35 -0700 Subject: RE: Alternare <html><body> <tt> Dear Dr. Vissers:<BR> <BR> I do not think that $150 is an excessive charge for an adjustment --<BR> now, you apparently do. This is exactly the problem. How can you<BR> objectively prove that that $150 is an excessive fee? <BR> <BR> If I were to charge that fee for an adjustment to a cash patient then<BR> that is between myself and the patient, not the OBCE or the State of<BR> Oregon. IF I were to charge that to an auto insurance then they would<BR> probably limit my fee to customary fees. I would have the choice to go<BR> to court where all would be decided by a judge or jury, at little or no<BR> cost to the OBCE. Seems simple enough. OBCE steps in with fee<BR> restrictions at considerable expense ($5000 for the defending<BR> chiropractor's legal fees for a lawyer with NO FEE RESTRICTIONS + OBCE<BR> legal fees from limited resources). <BR> <BR> Figure the adjustment fee of $150 goes to pay for an education (with 3<BR> board certifications) that costs over $150,000, plus my house that is<BR> about $300,000 plus my car at $30,000 and my 7 kids, 3 of whom are in<BR> college to the tune of $75,000 per year. And then there are incidentals<BR> like paying $5000 annually for the lawyers to protect me from government<BR> and insurance intrusions into my freedom to practice, and so on. You can<BR> see that it all adds up quickly. Would these be satisfactory criteria to<BR> set my fees? I bet not. It " should " be set up based upon what committee<BR> thought an Oregon chirorpactor deserved, since I am after all, only<BR> worth $50, even if someone is willing to cost me over $5000 to defend my<BR> fee. It seems like something that is so expensive to defend should be<BR> worth more than the price of its defense. So I think that $5000 per<BR> adjustment might be actually closer to a fee worth the trouble of<BR> defending it.<BR> <BR> As an additional example of this dilemma: what is the economic value of<BR> Yellowstone National Park? Is it just worth the value of the real<BR> estate? How about the value of replacing it with another park? How about<BR> the value of the feeling it gives you to just know that Yellowstone will<BR> be available for a future vacation? What about the value of the lost<BR> mineral and oil reserves? How about the political value for the opponent<BR> of the Presidential candidate who says they want to close it?<BR> <BR> As you can see setting fees should always be left to the market, since<BR> governments and even economists are usually poor at judging the value of<BR> services or goods. Last I looked, the OBCE was part of the government.<BR> Governments should set policies, not fees. Show me a government in<BR> history that permanently set the fees for its electorate and I will show<BR> you the history of a government in decline.<BR> <BR> Your intentions are good, but the results will be harmful to free<BR> enterprise. The end will not justify the means. It will only serve to<BR> embarrass the profession in a new way.<BR> <BR> Sincerely and respectfully,<BR> <BR> Willard Bertrand, D.C.<BR> <BR> <BR> <BR> Alternare<BR> I recently recieved an invitation to join some sort of managed<BR> care/insurer<BR> called ALTERNARE. They just started here in Arizona, but said they were<BR> one<BR> of the largest insurers in Washington and Oregon. They cover massage,<BR> chiropractic, acupuncture, nutritional counseling. Are any of you<BR> familiar<BR> with them?<BR> <BR> Anglen<BR> <BR> OregonDCs rules:<BR> 1. Keep correspondence professional; the purpose of the listserve is to<BR> foster communication and collegiality. No personal attacks on listserve<BR> members will be tolerated.<BR> 2. Always sign your e-mails with your first and last name.<BR> 3. The listserve is not secure; your e-mail could end up anywhere.<BR> However,<BR> it is against the rules of the listserve to copy, print, forward, or<BR> otherwise distribute correspondence written by another member without<BR> his or<BR> her consent, unless all personal identifiers have been removed.<BR> <BR> <BR> <BR> ---<BR> Incoming mail is certified Virus Free.<BR> Checked by AVG anti-virus system (<a href= " http://www.grisoft.com). " >http://www.grisoft.com).</a><BR> Version: 6.0.681 / Virus Database: 443 - Release Date: 5/10/2004<BR> <BR> <BR> OregonDCs rules:<BR> 1. Keep correspondence professional; the purpose of the listserve is to<BR> foster communication and collegiality. No personal attacks on listserve<BR> members will be tolerated.<BR> 2. Always sign your e-mails with your first and last name.<BR> 3. The listserve is not secure; your e-mail could end up anywhere.<BR> However,<BR> it is against the rules of the listserve to copy, print, forward, or<BR> otherwise distribute correspondence written by another member without<BR> his or<BR> her consent, unless all personal identifiers have been removed.<BR> <BR> <BR> <BR> <BR> <BR> <BR> OregonDCs rules:<BR> 1. Keep correspondence professional; the purpose of the listserve is to<BR> foster communication and collegiality. No personal attacks on listserve<BR> members will be tolerated.<BR> 2. Always sign your e-mails with your first and last name.<BR> 3. The listserve is not secure; your e-mail could end up anywhere.<BR> However,<BR> it is against the rules of the listserve to copy, print, forward, or<BR> otherwise distribute correspondence written by another member without<BR> his or<BR> her consent, unless all personal identifiers have been removed.<BR> <BR> <BR> <BR> ---<BR> Outgoing mail is certified Virus Free.<BR> Checked by AVG anti-virus system (<a href= " http://www.grisoft.com). " >http://www.grisoft.com).</a><BR> Version: 6.0.681 / Virus Database: 443 - Release Date: 5/10/2004<BR> <BR> ---<BR> Incoming mail is certified Virus Free.<BR> Checked by AVG anti-virus system (<a href= " http://www.grisoft.com). " >http://www.grisoft.com).</a><BR> Version: 6.0.681 / Virus Database: 443 - Release Date: 5/10/2004<BR> <BR> <BR> OregonDCs rules:<BR> 1. Keep correspondence professional; the purpose of the listserve is to<BR> foster communication and collegiality. No personal attacks on listserve<BR> members will be tolerated.<BR> 2. Always sign your e-mails with your first and last name.<BR> 3. The listserve is not secure; your e-mail could end up anywhere.<BR> However,<BR> it is against the rules of the listserve to copy, print, forward, or<BR> otherwise distribute correspondence written by another member without<BR> his or<BR> her consent, unless all personal identifiers have been removed.<BR> <BR> <BR> <BR> <BR> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2004 Report Share Posted May 18, 2004 Hi Dr. : Justification is such a complex word. You seem to say that a higher fee must be justified by some means, while a lower fee would not require such a justification. I do not think there should be a requirement for justification of a $150 fee since that is a perfectly reasonable fee and should be well below the justification level. Dr., since you apparently would require justification for a $150 adjustment fee, what would a suitable statement of justification include that would certainly and completely satisfy your proposed requirements for a $150 Fee? Would this also apply for a $300 adjustment fee? A $3000 fee? Willard Bertrand, D.C. Alternare<BR> I recently recieved an invitation to join some sort of managed<BR> care/insurer<BR> called ALTERNARE. They just started here in Arizona, but said they were<BR> one<BR> of the largest insurers in Washington and Oregon. They cover massage,<BR> chiropractic, acupuncture, nutritional counseling. Are any of you<BR> familiar<BR> with them?<BR> <BR> Anglen<BR> <BR> OregonDCs rules:<BR> 1. Keep correspondence professional; the purpose of the listserve is to<BR> foster communication and collegiality. No personal attacks on listserve<BR> members will be tolerated.<BR> 2. Always sign your e-mails with your first and last name.<BR> 3. The listserve is not secure; your e-mail could end up anywhere.<BR> However,<BR> it is against the rules of the listserve to copy, print, forward, or<BR> otherwise distribute correspondence written by another member without<BR> his or<BR> her consent, unless all personal identifiers have been removed.<BR> <BR> <BR> <BR> ---<BR> Incoming mail is certified Virus Free.<BR> Checked by AVG anti-virus system (<a href= " http://www.grisoft.com). " >http://www.grisoft.com).</a><BR> Version: 6.0.681 / Virus Database: 443 - Release Date: 5/10/2004<BR> <BR> <BR> OregonDCs rules:<BR> 1. Keep correspondence professional; the purpose of the listserve is to<BR> foster communication and collegiality. No personal attacks on listserve<BR> members will be tolerated.<BR> 2. Always sign your e-mails with your first and last name.<BR> 3. The listserve is not secure; your e-mail could end up anywhere.<BR> However,<BR> it is against the rules of the listserve to copy, print, forward, or<BR> otherwise distribute correspondence written by another member without<BR> his or<BR> her consent, unless all personal identifiers have been removed.<BR> <BR> <BR> <BR> <BR> <BR> <BR> OregonDCs rules:<BR> 1. Keep correspondence professional; the purpose of the listserve is to<BR> foster communication and collegiality. No personal attacks on listserve<BR> members will be tolerated.<BR> 2. Always sign your e-mails with your first and last name.<BR> 3. The listserve is not secure; your e-mail could end up anywhere.<BR> However,<BR> it is against the rules of the listserve to copy, print, forward, or<BR> otherwise distribute correspondence written by another member without<BR> his or<BR> her consent, unless all personal identifiers have been removed.<BR> <BR> <BR> <BR> ---<BR> Outgoing mail is certified Virus Free.<BR> Checked by AVG anti-virus system (<a href= " http://www.grisoft.com). " >http://www.grisoft.com).</a><BR> Version: 6.0.681 / Virus Database: 443 - Release Date: 5/10/2004<BR> <BR> ---<BR> Incoming mail is certified Virus Free.<BR> Checked by AVG anti-virus system (<a href= " http://www.grisoft.com). " >http://www.grisoft.com).</a><BR> Version: 6.0.681 / Virus Database: 443 - Release Date: 5/10/2004<BR> <BR> <BR> OregonDCs rules:<BR> 1. Keep correspondence professional; the purpose of the listserve is to<BR> foster communication and collegiality. No personal attacks on listserve<BR> members will be tolerated.<BR> 2. Always sign your e-mails with your first and last name.<BR> 3. The listserve is not secure; your e-mail could end up anywhere.<BR> However,<BR> it is against the rules of the listserve to copy, print, forward, or<BR> otherwise distribute correspondence written by another member without<BR> his or<BR> her consent, unless all personal identifiers have been removed.<BR> <BR> <BR> <BR> <BR> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2004 Report Share Posted May 18, 2004 Excellent points Dr. Bertrand, Here's another... I was called by two attorneys to depose me over a worker's compensation claim. I didn't REALLY want to go (having already written 3 narrative reports, free of charge, just trying to help the patient), so I told my receptionist to quote them $500.00/hour. They didn't even blink an eye. They told me to prepare for 1-3 hours out of office time. " Fine, " I thought. On the day of the deposition, I was well prepared, knew all the dates/facts/chart notes, and we were done in one hour. As I was leaving, the attorney for the patient asked me what I was charging the other two attorneys. I told her $500.00. She said, well...that's ok, but you should really consider raising your fees to $700.00/hour! She said that was the going rate for professional testimony!! I just walked out shaking my head... These people are playing at a totally different financial level than we are!...and they're playing with OUR money ( " our money " being tax dollars, private insurance premiums, auto insurance premiums, worker's compensation premiums, malpractice premiums etc, etc, etc...). So, really, the remaining question I have (even after Dr. Vern Saboe's excellent comments) is, where are the " excessive fee " rules " excessive treatment " rules for the other professions? If those professions DON'T have such rules, than we shouldn't either, and we should simply adopt THEIR professional, Board language--word for word!!! Then, if insurance or Legislators ask us for justification, we simply hold ourselves up as equal to the other professions (i.e., same fees/treatment frequencies as PT, MD, DO). If Insurance insists on accusing us of " excessive fees/treatment " than we go to the Legislature and demand that the insurance company PROVE IT!!! Had we done this with SAIF (i.e., a complete and independent financial audit) 1197 would have never stood. But, we took it on the chin then, and we're taking it on the chin now. By buckling under political pressure, and not standing up and demanding a fair, financial accounting by those accusing us of wrong doing, we're allowing them to smear and slander us in the Legislature. One of these times...we really need to stand our ground and fight! 99.9% of us were doing nothing wrong in 1990, but 100% of us paid the price. That same type of crucifixion is coming with PIP until we face our accusers, head-on, with a unified front, and demand an accounting of MD fees, DO fees, PT fees, and the insurance companies OWN CLAIMS MANAGEMENT FEES! (i.e., how can we allow insurance companies to complain to the Legislature about OUR fees, when THEY posted a 42% INCREASE in revenue last year....are we just STUPID, or what!?). M. s, D.C. (can I go home now... (:-) Alternare > I recently recieved an invitation to join some sort of managed > care/insurer > called ALTERNARE. They just started here in Arizona, but said they were > one > of the largest insurers in Washington and Oregon. They cover massage, > chiropractic, acupuncture, nutritional counseling. Are any of you > familiar > with them? > > Anglen > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to > foster communication and collegiality. No personal attacks on listserve > members will be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. > However, > it is against the rules of the listserve to copy, print, forward, or > otherwise distribute correspondence written by another member without > his or > her consent, unless all personal identifiers have been removed. > > > > --- > Incoming mail is certified Virus Free. > Checked by AVG anti-virus system (http://www.grisoft.com). > Version: 6.0.681 / Virus Database: 443 - Release Date: 5/10/2004 > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to > foster communication and collegiality. No personal attacks on listserve > members will be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. > However, > it is against the rules of the listserve to copy, print, forward, or > otherwise distribute correspondence written by another member without > his or > her consent, unless all personal identifiers have been removed. > > > > > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to > foster communication and collegiality. No personal attacks on listserve > members will be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. > However, > it is against the rules of the listserve to copy, print, forward, or > otherwise distribute correspondence written by another member without > his or > her consent, unless all personal identifiers have been removed. > > > > --- > Outgoing mail is certified Virus Free. > Checked by AVG anti-virus system (http://www.grisoft.com). > Version: 6.0.681 / Virus Database: 443 - Release Date: 5/10/2004 > > --- > Incoming mail is certified Virus Free. > Checked by AVG anti-virus system (http://www.grisoft.com). > Version: 6.0.681 / Virus Database: 443 - Release Date: 5/10/2004 > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to > foster communication and collegiality. No personal attacks on listserve > members will be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. > However, > it is against the rules of the listserve to copy, print, forward, or > otherwise distribute correspondence written by another member without > his or > her consent, unless all personal identifiers have been removed. > > > > > Quote Link to comment Share on other sites More sharing options...
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