Guest guest Posted July 3, 2006 Report Posted July 3, 2006 I am getting ready to file a complaint with the insurance commissioner but wanted to check with everyone else to see if they have had similar problems, and would also like to file. I recently received a letter on two patients that were involved in a MVA. This letter from their adjuster stated that they will only reimburse our office for treatment that was performed on the approved areas, as per their conversation with the patient/client. Doesn't this seem like they are deciding what treatment the patient gets? They did not examine their client, do not have a medical or Chiro degree, and should not be making medical decisions that would effect their care? I have spoken with these patients attorney and he agrees that a complaint should be filed. Does this ring a bell with anyone else? Lets do something about this before it gets out of hand! Kollar Hillsboro, OR Quote
Guest guest Posted July 4, 2006 Report Posted July 4, 2006 1. The Insurance Commissioner in this state has no teeth what-so- ever. I actually had one of the clock-punchers there tell me " that they were not in the business of collecting for doctors. " My response that this was an issue in which the insured/comsumer needed protection. Deaf ears. 2. Another time, I had a different pension-watcher there tell me that she would not take a complaint from my office and it had to come directly from the consumer. She then proceeded to to have lenghty discussions with the insurance company (Progressive) but not speak to me despite the fact that I could articulate the problem and reference the statutes. This was an issue in which a dinosaur IME doctor stated his opinion that this woman's low back complaints were not related to the MVA and therefore charges should be reduced 50%. My point was that Progressive could follow the recommendations blindly but that changing from a 98941 to a 98940 did not constitute a 50% reduction and that they were liable for 100% reimbursement of 98940. This also included therapy and re-examination codes. Insurance Commissioner would not even listen to the argument. 3. You definitely need to have the patient file the complaint. Write a draft letter and send it to the attorney and have them file it. If there was ever dead weight sitting around Salem, it is the Insurance Commissioner's office. The MRU dealing with work comp is much more helpful. Good Luck, , DC, LLC > > I am getting ready to file a complaint with the insurance commissioner but > wanted to check with everyone else to see if they have had similar problems, > and would also like to file. > I recently received a letter on two patients that were involved in a MVA. > This letter from their adjuster stated that they will only reimburse our office > for treatment that was performed on the approved areas, as per their > conversation with the patient/client. Doesn't this seem like they are deciding what > treatment the patient gets? They did not examine their client, do not have > a medical or Chiro degree, and should not be making medical decisions that > would effect their care? I have spoken with these patients attorney and he > agrees that a complaint should be filed. > Does this ring a bell with anyone else? Lets do something about this before > it gets out of hand! > Kollar > Hillsboro, OR > Quote
Guest guest Posted July 5, 2006 Report Posted July 5, 2006 Could the OBCE send a letter to the adjuster with cc to ins. company ceo and let them know that they are practicing Chiropractic w/o a license??? > I am getting ready to file a complaint with the insurance commissioner but > wanted to check with everyone else to see if they have had similar > problems, > and would also like to file. > I recently received a letter on two patients that were involved in a MVA. > This letter from their adjuster stated that they will only reimburse our > office > for treatment that was performed on the approved areas, as per their > conversation with the patient/client. Doesn't this seem like they are > deciding what > treatment the patient gets? They did not examine their client, do not > have > a medical or Chiro degree, and should not be making medical decisions > that > would effect their care? I have spoken with these patients attorney and > he > agrees that a complaint should be filed. > Does this ring a bell with anyone else? Lets do something about this > before > it gets out of hand! > Kollar > Hillsboro, OR > DR CHARLIE CAUGHLIN DC. CAC 155 NW 1ST AVE JOHN DAY, OR 97845 OFF-541-575-1063 FAX-541-575-5554 HM-541-575-1103 Quote
Guest guest Posted July 5, 2006 Report Posted July 5, 2006 This has been a bug-a-boo with me every time I get one of these letters .... how do they get away with 'practicing without a license' .... they are nowhere near understanding the patient's concerns NOR the technique concerns. They seem to have no ability to understand that if I adjust only the accident complaints, that I will actually create more of a monster of a problem. Pretty simplistic and a**nine to me. they gamble on the fact that it is too expensive to go after them. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C Eugene, Oregon, 97401 541- 344- 0509; Fx; 541- 344- 0955 From: "Dr. Charlie Caughlin DC" <caughlindrc@...>dkollardc@...CC: Subject: Re: Progressive InsDate: Wed, 5 Jul 2006 07:49:37 -0700 (PDT)Could the OBCE send a letter to the adjuster with cc to ins. company ceoand let them know that they are practicing Chiropractic w/o a license???> I am getting ready to file a complaint with the insurance commissioner but> wanted to check with everyone else to see if they have had similar> problems,> and would also like to file.> I recently received a letter on two patients that were involved in a MVA.> This letter from their adjuster stated that they will only reimburse our> office> for treatment that was performed on the approved areas, as per their> conversation with the patient/client. Doesn't this seem like they are> deciding what> treatment the patient gets? They did not examine their client, do not> have> a medical or Chiro degree, and should not be making medical decisions> that> would effect their care? I have spoken with these patients attorney and> he> agrees that a complaint should be filed.> Does this ring a bell with anyone else? Lets do something about this> before> it gets out of hand!> Kollar> Hillsboro, OR>DR CHARLIE CAUGHLIN DC. CAC155 NW 1ST AVEJOHN DAY, OR 97845OFF-541-575-1063FAX-541-575-5554HM-541-575-1103 Quote
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