Re: How do I appeal an AIG W/C denial?

[Guest guest]

I wish I had a good answer for your problem Doc. However, you do illustrate an EXTREMELY important point:

Notice how simplistic a prescription from an M.D. can be in order to get "manipulation" or "adjustments" paid by an insurance company! (no NMS tests, Goniometer ROM, pre-post documentation of improvement, no objective PROOF that the patient needs an adjustment....AT ALL!). Just the doctor's OPINION!

I suggest to all of you trying to define us beyond the standards of the rest of the health care profession...to take a very close look at reality. It's not what we do; it's who we are.

Physical Therapists are recognized Federally to manipulate the spine; yet they're not TRAINED in manipulation (nor can they DIAGNOSE, i.e. "objective test" the need for said adjustment in the first place).

And what's worse....a MEDICAL DOCTOR WITH NO TRAINING IN SUBLUXATION DETECTION AND TREATMENT CAN PRESCRIBE MANIPULATION, AND GET BETTER INSURANCE REIMBURSEMENT THAN US!

RR.

How do I appeal an AIG W/C denial?

Just got off the phone with this automaton drone from AIG. She is denying a low back claim that was fixed in three visits. The patient was referred from one of the occupational medicine doctors here in town.

When he sends people down here he always writes on a prescription pad the same thing: “Chiropractic care – evaluate and treat with modalities and manipulation – 4-6 visits” and the diagnosis. We send a photocopy of that prescription in with all the bills, he maintains attending physician status, patient gets better, we get paid and everyone’s happy.

Except with AIG. She denies the claim because the attending physician didn’t send in a signed treatment plan WITH objectives of EACH modality within 30 days as required by OAR 436-010-0230(4)(a)

She kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a break lady, sheesh. Like she’s going to be deciding what’s appropriate and indicated.

The attending physician already has written her a letter.

So the questions I have are:

- where can I get a copy of freaking OAR 436-010-0230(4)(a)?

- who do I appeal this to? AIG? Or DCBS?

- how do I maintain some sense of dignity and decorum when discussing these matters with certifiable morons?

- if (when) I lose my dignity and decorum and begin to let the expletives fly, how do I get the resultant spit flecks out of my telephone handset?

Don , DC

Corvallis (west of Sweet Home)

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.

[Guest guest]

Don,

Take an unblemished dead lamb, split a pidgeon in half, find a turtle or newt; lay them on an alter made of Oregon sandstone. Place your denial on top with the letterhead facing true magnetic north. Set it all on fire. The smoke will cause them to take quick and decisive action including sending their phone to voice mail and going to lunch.

Seriously, I have written out what I " think " the doctor meant (very specific with each modality, and so on); I then faxed it to the doc with a heads up for doctor's staff; they then copy it onto his letterhead paper; have him review it and if he agrees, sign it and send it back.

I submit that and it seems to work. Then I drive home VERY CAREFULLY as it appears that some of those adjusters have actual driver's licenses and cars.

Abrahamson, D.C.

From: " Don " <don@...>

Date: Tue, 29 Apr 2003 14:49:25 -0700

< >

Subject: How do I appeal an AIG W/C denial?

Just got off the phone with this automaton drone from AIG. She is denying a low back claim that was fixed in three visits. The patient was referred from one of the occupational medicine doctors here in town.

When he sends people down here he always writes on a prescription pad the same thing: ³Chiropractic care ­ evaluate and treat with modalities and manipulation ­ 4-6 visits² and the diagnosis. We send a photocopy of that prescription in with all the bills, he maintains attending physician status, patient gets better, we get paid and everyone¹s happy.

Except with AIG. She denies the claim because the attending physician didn¹t send in a signed treatment plan WITH objectives of EACH modality within 30 days as required by OAR 436-010-0230(4)(a)

She kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a break lady, sheesh. Like she¹s going to be deciding what¹s appropriate and indicated.

The attending physician already has written her a letter.

So the questions I have are:

- where can I get a copy of freaking OAR 436-010-0230(4)(a)?

- who do I appeal this to? AIG? Or DCBS?

- how do I maintain some sense of dignity and decorum when discussing these matters with certifiable morons?

- if (when) I lose my dignity and decorum and begin to let the expletives fly, how do I get the resultant spit flecks out of my telephone handset?

Don , DC

Corvallis (west of Sweet Home)

[Guest guest]

Don and colleagues this gal is correct I've gone through the very same BS and have built a specific chart note within my chart note software for this very situation...I'm at home right now but will post the paragraph with a place for the MD to sing to the list serve tomorrow.

Vern

How do I appeal an AIG W/C denial?

Just got off the phone with this automaton drone from AIG. She is denying a low back claim that was fixed in three visits. The patient was referred from one of the occupational medicine doctors here in town.

When he sends people down here he always writes on a prescription pad the same thing: “Chiropractic care – evaluate and treat with modalities and manipulation – 4-6 visits” and the diagnosis. We send a photocopy of that prescription in with all the bills, he maintains attending physician status, patient gets better, we get paid and everyone’s happy.

Except with AIG. She denies the claim because the attending physician didn’t send in a signed treatment plan WITH objectives of EACH modality within 30 days as required by OAR 436-010-0230(4)(a)

She kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a break lady, sheesh. Like she’s going to be deciding what’s appropriate and indicated.

The attending physician already has written her a letter.

So the questions I have are:

- where can I get a copy of freaking OAR 436-010-0230(4)(a)?

- who do I appeal this to? AIG? Or DCBS?

- how do I maintain some sense of dignity and decorum when discussing these matters with certifiable morons?

- if (when) I lose my dignity and decorum and begin to let the expletives fly, how do I get the resultant spit flecks out of my telephone handset?

Don , DC

Corvallis (west of Sweet Home)

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.

[Guest guest]

Ha...ah ya crack me up !

Vern Saboe

How do I appeal an AIG W/C denial?

Just got off the phone with this automaton drone from AIG. She is denying a low back claim that was fixed in three visits. The patient was referred from one of the occupational medicine doctors here in town. When he sends people down here he always writes on a prescription pad the same thing: ³Chiropractic care ­ evaluate and treat with modalities and manipulation ­ 4-6 visits² and the diagnosis. We send a photocopy of that prescription in with all the bills, he maintains attending physician status, patient gets better, we get paid and everyone¹s happy. Except with AIG. She denies the claim because the attending physician didn¹t send in a signed treatment plan WITH objectives of EACH modality within 30 days as required by OAR 436-010-0230(4)(a) She kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a break lady, sheesh. Like she¹s going to be deciding what¹s appropriate and indicated. The attending physician already has written her a letter. So the questions I have are: - where can I get a copy of freaking OAR 436-010-0230(4)(a)? - who do I appeal this to? AIG? Or DCBS? - how do I maintain some sense of dignity and decorum when discussing these matters with certifiable morons? - if (when) I lose my dignity and decorum and begin to let the expletives fly, how do I get the resultant spit flecks out of my telephone handset? Don , DC Corvallis (west of Sweet Home)

[Guest guest]

Vern: I don't think I want to hear any MD's I know singing. Don't you mean sign?

Ann Goldeen

How do I appeal an AIG W/C denial?

Just got off the phone with this automaton drone from AIG. She is denying a low back claim that was fixed in three visits. The patient was referred from one of the occupational medicine doctors here in town.

When he sends people down here he always writes on a prescription pad the same thing: “Chiropractic care – evaluate and treat with modalities and manipulation – 4-6 visits” and the diagnosis. We send a photocopy of that prescription in with all the bills, he maintains attending physician status, patient gets better, we get paid and everyone’s happy.

Except with AIG. She denies the claim because the attending physician didn’t send in a signed treatment plan WITH objectives of EACH modality within 30 days as required by OAR 436-010-0230(4)(a)

She kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a break lady, sheesh. Like she’s going to be deciding what’s appropriate and indicated.

The attending physician already has written her a letter.

So the questions I have are:

- where can I get a copy of freaking OAR 436-010-0230(4)(a)?

- who do I appeal this to? AIG? Or DCBS?

- how do I maintain some sense of dignity and decorum when discussing these matters with certifiable morons?

- if (when) I lose my dignity and decorum and begin to let the expletives fly, how do I get the resultant spit flecks out of my telephone handset?

Don , DC

Corvallis (west of Sweet Home)

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.

[Guest guest]

Oops..to many hours up at the capital, on the phone, CAO business, etc., etc. and not enough on the golf course...which reminds me..what the hell am I doing up right now!

VErn Saboe

How do I appeal an AIG W/C denial?

Just got off the phone with this automaton drone from AIG. She is denying a low back claim that was fixed in three visits. The patient was referred from one of the occupational medicine doctors here in town.

When he sends people down here he always writes on a prescription pad the same thing: “Chiropractic care – evaluate and treat with modalities and manipulation – 4-6 visits” and the diagnosis. We send a photocopy of that prescription in with all the bills, he maintains attending physician status, patient gets better, we get paid and everyone’s happy.

Except with AIG. She denies the claim because the attending physician didn’t send in a signed treatment plan WITH objectives of EACH modality within 30 days as required by OAR 436-010-0230(4)(a)

She kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a break lady, sheesh. Like she’s going to be deciding what’s appropriate and indicated.

The attending physician already has written her a letter.

So the questions I have are:

- where can I get a copy of freaking OAR 436-010-0230(4)(a)?

- who do I appeal this to? AIG? Or DCBS?

- how do I maintain some sense of dignity and decorum when discussing these matters with certifiable morons?

- if (when) I lose my dignity and decorum and begin to let the expletives fly, how do I get the resultant spit flecks out of my telephone handset?

Don , DC

Corvallis (west of Sweet Home)

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.

[Guest guest]

Hi Don,

i had a similar problem about a year ago. I think I mentioned it on the listserv. Yes, there is a rule that will prove the automaton drone correct. Very few claim reps hold us to the standard. i can't find it right now. I contacted the MD who was referring me and created a form that included objectives of care....decreased pain, increased range ofmotion etc. I lost the money on my claim and was unable to reclaim it. Now I make sure the Rx from the MD has all the parameters included. The WC claim person actually sent me a copy of the rule. Frequency, duration, objectives of care, type of treatment and diagnosis. If you work with any PT's use one of their forms. It's the same rule. I'm just the messenger, please don't think I'm happy with this bit of news. I hope everyone reads this,cause there are more and more claims reps using the letter of the rule to deny payment.

Minga Guerrero DC

Portland OR

In a message dated 4/29/2003 3:42:58 PM Pacific Daylight Time, don@... writes:

Just got off the phone with this automaton drone from AIG. She is denying a low back claim that was fixed in three visits. The patient was referred from one of the occupational medicine doctors here in town.

When he sends people down here he always writes on a prescription pad the same thing: “Chiropractic care – evaluate and treat with modalities and manipulation – 4-6 visits†and the diagnosis. We send a photocopy of that prescription in with all the bills, he maintains attending physician status, patient gets better, we get paid and everyone’s happy.

Except with AIG. She denies the claim because the attending physician didn’t send in a signed treatment plan WITH objectives of EACH modality within 30 days as required by OAR 436-010-0230(4)(a)

She kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a break lady, sheesh. Like she’s going to be deciding what’s appropriate and indicated.

The attending physician already has written her a letter.

So the questions I have are:

- where can I get a copy of freaking OAR 436-010-0230(4)(a)?

- who do I appeal this to? AIG? Or DCBS?

- how do I maintain some sense of dignity and decorum when discussing these matters with certifiable morons?

- if (when) I lose my dignity and decorum and begin to let the expletives fly, how do I get the resultant spit flecks out of my telephone handset?

Don , DC

Corvallis (west of Sweet Home)

[Guest guest]

Dr. Guerrero:

Would you

be so helpful as to post the form you are using. I have had a similar

experience.

Willard

-----Original

Message-----

From: AboWoman@...

[mailto:AboWoman@...]

Sent: Wednesday, April 30, 2003

5:30 PM

Subject: Re: How do I

appeal an AIG W/C denial?

Hi Don,

i had a similar problem about a year ago. I think I mentioned it on the

listserv. Yes, there is a rule that will prove the automaton drone correct.

Very few claim reps hold us to the standard. i can't find it right now. I contacted

the MD who was referring me and created a form that included objectives of

care....decreased pain, increased range ofmotion etc. I lost the money on my

claim and was unable to reclaim it. Now I make sure the Rx from the MD has all

the parameters included. The WC claim person actually sent me a copy of the

rule. Frequency, duration, objectives of care, type of treatment and diagnosis.

If you work with any PT's use one of their forms. It's the same rule. I'm just

the messenger, please don't think I'm happy with this bit of news. I hope

everyone reads this,cause there are more and more claims reps using the letter

of the rule to deny payment.

Minga Guerrero DC

Portland OR

In a message dated 4/29/2003 3:42:58 PM Pacific Daylight Time,

don@... writes:

Just got off the phone with this automaton drone from AIG. She is denying

a low back claim that was fixed in three visits. The patient was referred

from one of the occupational medicine doctors here in town.

When he

sends people down here he always writes on a prescription pad the same

thing: “Chiropractic care – evaluate and treat with modalities and

manipulation – 4-6 visits†and the diagnosis. We send a photocopy of that

prescription in with all the bills, he maintains attending physician status,

patient gets better, we get paid and everyone’s happy.

Except

with AIG. She denies the claim because the attending physician didn’t

send in a signed treatment plan WITH objectives of EACH modality within 30 days

as required by OAR 436-010-0230(4)(a)

She

kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a

break lady, sheesh. Like she’s going to be deciding what’s appropriate

and indicated.

The

attending physician already has written her a letter.

So the

questions I have are:

- where

can I get a copy of freaking OAR 436-010-0230(4)(a)?

- who

do I appeal this to? AIG? Or DCBS?

- how

do I maintain some sense of dignity and decorum when discussing these matters

with certifiable morons?

- if (when)

I lose my dignity and decorum and begin to let the expletives fly, how do I get

the resultant spit flecks out of my telephone handset?

Don

, DC

Corvallis

(west of Sweet Home)

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.

[Guest guest]

This is the form we use in our clinic.

Seitz, DC Tuality Physicians

730-D SE Oak St

Hillsboro, OR 97123

(503)640-3724

>From: "Dr. Willard Bertrand, D.C."

>

>Subject: RE: How do I appeal an AIG W/C denial?

>Date: Wed, 30 Apr 2003 18:33:40 -0700

>

>Dr. Guerrero:

>

>Would you be so helpful as to post the form you are using. I have had a similar experience.

>

>Willard

>

> Re: How do I appeal an AIG W/C denial?

>

>Hi Don,

>i had a similar problem about a year ago. I think I mentioned it on the listserv. Yes, there is a rule that will prove the automaton drone correct. Very few claim reps hold us to the standard. i can't find it right now. I contacted the MD who was referring me and created a form that included objectives of care....decreased pain, increased range ofmotion etc. I lost the money on my claim and was unable to reclaim it. Now I make sure the Rx from the MD has all the parameters included. The WC claim person actually sent me a copy of the rule. Frequency, duration, objectives of care, type of treatment and diagnosis. If you work with any PT's use one of their forms. It's the same rule. I'm just the messenger, please don't think I'm happy with this bit of news. I hope everyone reads this,cause there are more and more claims reps using the letter of the rule to deny payment.

>Minga Guerrero DC

>Portland OR

>

>In a message dated 4/29/2003 3:42:58 PM Pacific Daylight Time, don@... writes:

>

>

>

>

>

>Just got off the phone with this automaton drone from AIG. She is denying a low back claim that was fixed in three visits. The patient was referred from one of the occupational medicine doctors here in town.

>

>

>

>When he sends people down here he always writes on a prescription pad the same thing: “Chiropractic care – evaluate and treat with modalities and manipulation – 4-6 visits†and the diagnosis. We send a photocopy of that prescription in with all the bills, he maintains attending physician status, patient gets better, we get paid and everyone’s happy.

>

>

>

>Except with AIG. She denies the claim because the attending physician didn’t send in a signed treatment plan WITH objectives of EACH modality within 30 days as required by OAR 436-010-0230(4)(a)

>

>

>

>She kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a break lady, sheesh. Like she’s going to be deciding what’s appropriate and indicated.

>

>

>

>The attending physician already has written her a letter.

>

>

>

>So the questions I have are:

>

>

>

>- where can I get a copy of freaking OAR 436-010-0230(4)(a)?

>

>- who do I appeal this to? AIG? Or DCBS?

>

>- how do I maintain some sense of dignity and decorum when discussing these matters with certifiable morons?

>

>- if (when) I lose my dignity and decorum and begin to let the expletives fly, how do I get the resultant spit flecks out of my telephone handset?

>

>

>

>Don , DC

>

>Corvallis (west of Sweet Home)

>

>

>

>

>

>

>

>

>

>

[Guest guest]



Dr. Bertrand,

This is a form we made for our office. It has worked well for us with no denials.

Respectfully,

B. Siegel,DC

(Your office name, Dr.’s name, address, phone and fax numbers)

WORKERS COMP REFERRAL FORM

Workers Comp. Law requires Chiropractic Visits to be very specifically requested and reviewed. Before we can see your patient, the following is needed, either on this form, or written and signed by the doctor in a chart note.

Date:

Name of patient:

RX, including by not limited to:

Care needed: ie…..examination, manipulation, physical therapy, electrical stimulation, ultrasound, etc.

Diagnosis:

Frequency:

Duration of treatment:

Goals: ie….reduction of pain by %, increased ROM by %, etc.

Name and Address Stamp (referring Dr.)

Signature of Referring Physician_____________________________________

Date:______________________

RE: How do I appeal an AIG W/C denial?

Dr. Guerrero:

Would you be so helpful as to post the form you are using. I have had a similar experience.

Willard

-----Original Message-----From: AboWoman@... [mailto:AboWoman@...]Sent: Wednesday, April 30, 2003 5:30 PM Subject: Re: How do I appeal an AIG W/C denial?

Hi Don,i had a similar problem about a year ago. I think I mentioned it on the listserv. Yes, there is a rule that will prove the automaton drone correct. Very few claim reps hold us to the standard. i can't find it right now. I contacted the MD who was referring me and created a form that included objectives of care....decreased pain, increased range ofmotion etc. I lost the money on my claim and was unable to reclaim it. Now I make sure the Rx from the MD has all the parameters included. The WC claim person actually sent me a copy of the rule. Frequency, duration, objectives of care, type of treatment and diagnosis. If you work with any PT's use one of their forms. It's the same rule. I'm just the messenger, please don't think I'm happy with this bit of news. I hope everyone reads this,cause there are more and more claims reps using the letter of the rule to deny payment.Minga Guerrero DCPortland ORIn a message dated 4/29/2003 3:42:58 PM Pacific Daylight Time, don@... writes:

Just got off the phone with this automaton drone from AIG. She is denying a low back claim that was fixed in three visits. The patient was referred from one of the occupational medicine doctors here in town. When he sends people down here he always writes on a prescription pad the same thing: “Chiropractic care – evaluate and treat with modalities and manipulation – 4-6 visits†and the diagnosis. We send a photocopy of that prescription in with all the bills, he maintains attending physician status, patient gets better, we get paid and everyone’s happy. Except with AIG. She denies the claim because the attending physician didn’t send in a signed treatment plan WITH objectives of EACH modality within 30 days as required by OAR 436-010-0230(4)(a) She kept making a big deal out of the OBJECTIVES of EACH modality. Gimme a break lady, sheesh. Like she’s going to be deciding what’s appropriate and indicated. The attending physician already has written her a letter. So the questions I have are: - where can I get a copy of freaking OAR 436-010-0230(4)(a)?- who do I appeal this to? AIG? Or DCBS?- how do I maintain some sense of dignity and decorum when discussing these matters with certifiable morons?- if (when) I lose my dignity and decorum and begin to let the expletives fly, how do I get the resultant spit flecks out of my telephone handset? Don , DCCorvallis (west of Sweet Home)

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.

[Guest guest]

Sounds like the good makuns fer a gud ol burb-a-q but the society fo the

protection of half pigeons and long lost newts will block it in the courts!!

not to mention burnung in a protected area... the lamb feds will have a hay

day with thatr one!!!

Dr. Charlie Caughlin DC

155 NW 1st Ave

Day, Or 97845

off 541-575-1063

hm 541-575-1103

fax 541-575-5554

----- How do I appeal an AIG W/C denial?

>

> Just got off the phone with this automaton drone from AIG. She

> is denying a low back claim that was fixed in three visits. The

> patient was referred from one of the occupational medicine doctors

> here in town.

>

> When he sends people down here he always writes on a

> prescription pad the same thing: ³Chiropractic care ­ evaluate and

> treat with modalities and manipulation ­ 4-6 visits² and the

> diagnosis. We send a photocopy of that prescription in with all the

> bills, he maintains attending physician status, patient gets better,

> we get paid and everyone¹s happy.

>

> Except with AIG. She denies the claim because the attending

> physician didn¹t send in a signed treatment plan WITH objectives of

> EACH modality within 30 days as required by OAR 436-010-0230(4)(a)

>

> She kept making a big deal out of the OBJECTIVES of EACH

> modality. Gimme a break lady, sheesh. Like she¹s going to be

> deciding what¹s appropriate and indicated.

>

> The attending physician already has written her a letter.

>

> So the questions I have are:

>

> - where can I get a copy of freaking OAR 436-010-0230(4)(a)?

>

> - who do I appeal this to? AIG? Or DCBS?

>

> - how do I maintain some sense of dignity and decorum when

> discussing these matters with certifiable morons?

>

> - if (when) I lose my dignity and decorum and begin to let the

> expletives fly, how do I get the resultant spit flecks out of my

> telephone handset?

>

> Don , DC

>

> Corvallis (west of Sweet Home)

>

>