Re: PIP Fee dispute question

[Guest guest]

,

Nice to see a on-topic post! I don't have a response to your querry but you stimulated a gag reflex with your post so I thought I'd purge. Just saw a patient today, 5th visit since initial visit on 9/24. Pt. had not returned as scheduled because "the insurance company (safeco) told me they wouldn't pay for any chiropractic care until I went to an IME". Saw someone in Lake Oswego who recommended "keep doing what your doing, it's helping", so she was "allowed" to return for care. Her original MVA was 6/9/04 and she had 7 PT visits b/t that date and early September, which helped, but obviously didn't guide her to complete resolution. My bitch is that this insurance company got between me and my patient, after only 4 visits, which by the way was helping quite a bit, and did not have the concern to notify my office... not a word. Now, Safeco is not "her" insurer, I believe her insurer is Allstate, but how is this legal?

Seitz, DC Tuality Physicians

730-D SE Oak St

Hillsboro, OR 97123

(503)640-3724 >From: "Dr. Abrahamson" <drscott@...> >oregon dcs < > >Subject: PIP Fee dispute question >Date: Fri, 29 Oct 2004 16:00:40 -0700 > > >My staff tell me an adjuster told them we will be paid for a PI claim which >was med. Stat. 2 months ago. >They will however, be whacking the bill somewhat and we are told that we >cannot bill the patient for the balance. >They cite a statute and I think they are focusing on usual and customary >wording. >I've always been told by adjusters that my fees are at or below usual and >customary but these guys think otherwise. >I have my patients sign a form indicating that insurance reimbursement is >nice but that this "care for money" arrangement (to put it crudely) is >ultimately an agreement between me and them. > >This is the citing of the statute: >http://www.leg.state.or.us/03reg/measures/sb0400.dir/sb0486.intro.html > >Thoughts? > > >(Dr. Abrahamson, D.C.) >Chiropractic physician >Lake Oswego Chiropractic Clinic >315 Second Street >Lake Oswego, OR 97034 >503-635-6246 > > > >

[Guest guest]

, This is from sec.1 paragraph a): Do the time frames here apply in your case ? This was actually a bill to raise PIP coverage from 10,000 to 25,000, otherwise, essentially everything else is the same. sharron fuchs dc

'Expenses of medical,hospital, dental, surgical, ambulance and prosthetic servicesshall be presumed to be reasonable and necessary unless theprovider is given notice of denial of the charges not more than60 calendar days after the insurer receives from the providernotice of the claim for the services. At any time during thefirst 50 calendar days after the insurer receives notice ofclaim, the provider shall, within 10 business days, answer inwriting questions from the insurer regarding the claim. Forpurposes of determining when the 60-day period provided by thisparagraph has elapsed, counting of days shall be suspended if theprovider does not supply written answers to the insurer within 10days and shall not resume until the answers are supplied'

PIP Fee dispute questionMy staff tell me an adjuster told them we will be paid for a PI claim whichwas med. Stat. 2 months ago.They will however, be whacking the bill somewhat and we are told that wecannot bill the patient for the balance.They cite a statute and I think they are focusing on usual and customarywording.I've always been told by adjusters that my fees are at or below usual andcustomary but these guys think otherwise.I have my patients sign a form indicating that insurance reimbursement isnice but that this "care for money" arrangement (to put it crudely) isultimately an agreement between me and them.This is the citing of the statute:http://www.leg.state.or.us/03reg/measures/sb0400.dir/sb0486.intro.htmlThoughts?(Dr. Abrahamson, D.C.)Chiropractic physicianLake Oswego Chiropractic Clinic315 Second StreetLake Oswego, OR 97034503-635-6246OregonDCs 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]

:

Do you know if the PCP MD who ordered the PT deemed the patient fine following her 7th PT visit? Understanding that the PCP could have made such comment in his/her chart and the Ins. Co. claims rep is jumping on it...hence the supposed need for an IME.

Vern SAboe

PIP Fee dispute question >Date: Fri, 29 Oct 2004 16:00:40 -0700 > > >My staff tell me an adjuster told them we will be paid for a PI claim which >was med. Stat. 2 months ago. >They will however, be whacking the bill somewhat and we are told that we >cannot bill the patient for the balance. >They cite a statute and I think they are focusing on usual and customary >wording. >I've always been told by adjusters that my fees are at or below usual and >customary but these guys think otherwise. >I have my patients sign a form indicating that insurance reimbursement is >nice but that this "care for money" arrangement (to put it crudely) is >ultimately an agreement between me and them. > >This is the citing of the statute: >http://www.leg.state.or.us/03reg/measures/sb0400.dir/sb0486.intro.html > >Thoughts? > > >(Dr. Abrahamson, D.C.) >Chiropractic physician >Lake Oswego Chiropractic Clinic >315 Second Street >Lake Oswego, OR 97034 >503-635-6246 > > > >

[Guest guest]

Something has to be done about this nonesense. I'm beginning to wonder myself whether or not I am actually a doctor, kind of a doctor, sometimes and in under some circumstances a physician or what. The double standard is becoming rediculous especially as it relates to your post about IME evaluations and Workers compensation cases. Saif sends a letter to the patient basically telling them that Chiropractors are not physicians and they must switch to an MD or (get this) a Nurse practitioner in order to avoid interruption in benefits. Now, they make no mention of the 12/30 deal at all. Talk about confusing for the patient, and a crock for the chiropractor.

Joe Medlin dc

pdx

PIP Fee dispute question >Date: Fri, 29 Oct 2004 16:00:40 -0700 > > >My staff tell me an adjuster told them we will be paid for a PI claim which >was med. Stat. 2 months ago. >They will however, be whacking the bill somewhat and we are told that we >cannot bill the patient for the balance. >They cite a statute and I think they are focusing on usual and customary >wording. >I've always been told by adjusters that my fees are at or below usual and >customary but these guys think otherwise. >I have my patients sign a form indicating that insurance reimbursement is >nice but that this "care for money" arrangement (to put it crudely) is >ultimately an agreement between me and them. > >This is the citing of the statute: >http://www.leg.state.or.us/03reg/measures/sb0400.dir/sb0486.intro.html > >Thoughts? > > >(Dr. Abrahamson, D.C.) >Chiropractic physician >Lake Oswego Chiropractic Clinic >315 Second Street >Lake Oswego, OR 97034 >503-635-6246 > > > >

[Guest guest]

Joe... welcome to the back of the bus!!!

> Something has to be done about this nonesense. I'm beginning to wonder

> myself whether or not I am actually a doctor, kind of a doctor,

> sometimes and in under some circumstances a physician or what. The

> double standard is becoming rediculous especially as it relates to your

> post about IME evaluations and Workers compensation cases. Saif sends a

> letter to the patient basically telling them that Chiropractors are not

> physicians and they must switch to an MD or (get this) a Nurse

> practitioner in order to avoid interruption in benefits. Now, they make

> no mention of the 12/30 deal at all. Talk about confusing for the

> patient, and a crock for the chiropractor. Joe Medlin dc

> pdx

> RE: PIP Fee dispute question

>

>

>

>

>

>

> ,

>

> Nice to see a on-topic post! I don't have a response to your querry

> but you stimulated a gag reflex with your post so I thought I'd purge.

> Just saw a patient today, 5th visit since initial visit on 9/24. Pt.

> had not returned as scheduled because " the insurance company (safeco)

> told me they wouldn't pay for any chiropractic care until I went to an

> IME " . Saw someone in Lake Oswego who recommended " keep doing what your

> doing, it's helping " , so she was " allowed " to return for care. Her

> original MVA was 6/9/04 and she had 7 PT visits b/t that date and

> early September, which helped, but obviously didn't guide her to

> complete resolution. My bitch is that this insurance company got

> between me and my patient, after only 4 visits, which by the way was

> helping quite a bit, and did not have the concern to notify my

> office... not a word. Now, Safeco is not " her " insurer, I believe her

> insurer is Allstate, but how is this legal?

>

>

>

>

>

>

>

>

>

> Seitz, DC

> Tuality Physicians

> 730-D SE Oak St

> Hillsboro, OR 97123

>

> 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.

>

>

>