Re: Ernst denials from USAA and AIS

[Guest guest]

I had that same issue. I went back and forth with USAA, sending in

the OBCE Guidelines as the only parameter I had to follow, and they

basically just laughed in my face. What I did was to bill the

patient directly for the services I performed. I didn't get

anywhere with USAA, but I know the patient put them through bloody

hell. We didn't write off the balance, and the patient had to pay,

so I know he was ticked off, a little at me, but more so at USAA.

Let the cow manure run uphill for a change, and let the patient go

after them.

Ron Grice, DC

Albany, OR

On 1/19/2011 4:06 PM, g macdonald wrote:

Hello Gang,

Not sure if this was the group that discussed this

but here it goes:

If you are treating USAA (who is using AIS for

their clearing house), I got a new denial for you

to chew on:

Our lovely DC that is doing a paper review is

citing Ernst (an MD that is VERY anti chiropractic

- just check out quackwatch) as a means of denying

massage therapy and chiropractic. And then

calling the treatment excessive.

Am I whining? Yes, especially since I am still

within the parameters of the Croft guidelines and

our own OBCE guidelines.

Anyone else have this issue?

Garreth Mac

Eugene OR

[Guest guest]

I have the same issue with USAA and Auto injury solutions, I appealed it twice using OBCE and Croft's guidelines only to be told I it was excessive treatment. The patient is now going to the Insurance Commission with a complaint. If anyone knows of any other avenues it would be appreciated.

M Crockett DC

Salem, Oregon

Ernst denials from USAA and AIS

Hello Gang,Not sure if this was the group that discussed this but here it goes:If you are treating USAA (who is using AIS for their clearing house), I got a new denial for you to chew on:Our lovely DC that is doing a paper review is citing Ernst (an MD that is VERY anti chiropractic - just check out quackwatch) as a means of denying massage therapy and chiropractic. And then calling the treatment excessive.Am I whining? Yes, especially since I am still within the parameters of the Croft guidelines and our own OBCE guidelines.Anyone else have this issue?Garreth MacEugene OR

[Guest guest]



Well yes, as I said Ron consider having someone like me and independant expert review the file and render a counter opinion which can be referred to in Peer Review and by the Courts when you patient's attorney files a suit against the PIP carrier. Also if in fact the file review and conclusion are baloney by Auto Injury Solutions I will add my complaint to the OBCE as well. Further my written opinon as your colleague Board Certified in neurology, orthopedics, and forensic science who served four years on the OBCE Peer Review Committee and Nominal Panel of the Guidelines committee will have weight in the PIP suit......Vern Saboe

Ernst denials from USAA and AIS

Hello Gang,Not sure if this was the group that discussed this but here it goes:If you are treating USAA (who is using AIS for their clearing house), I got a new denial for you to chew on:Our lovely DC that is doing a paper review is citing Ernst (an MD that is VERY anti chiropractic - just check out quackwatch) as a means of denying massage therapy and chiropractic. And then calling the treatment excessive.Am I whining? Yes, especially since I am still within the parameters of the Croft guidelines and our own OBCE guidelines.Anyone else have this issue?Garreth MacEugene OR

[Guest guest]

Dr. Mac, if you would like to contact me directly via email or phone, I’d be happy to discuss this matter with you and recommend some remedies.

First, with respect to Dr. Ernst, I’ve read several of his systematic reviews, and they are of fairly poor quality. He is not highly regarded as a researcher. He avoids using databases

where the literature is likely to be more supportive of SMT, and I think he tends to downgrade the published literature found on the more commonly used databases like Medline. If there is a chiropractic reviewer who is relying on Ernst as justification for

denying care, that doc may be treading on thin ice.

Secondly, I agree with Dr. Grice’s approach. I think it’s important to understand the contractual relationships between your patient and yourself, on the one hand, and between your patient

and his/her insurer on the other. You cannot just stop seeing a patient because their PIP coverage was discontinued without risking being accused of abandonment. If your opinion is that the patient needs more care, then you have to work out some other arrangement

with the patient or allow the patient to drop out of care for inability to pay.

J. Burke, DC, DABCO

Associate Professor

University of Western States

Gresham Integrated Care

1304 NW Civic Drive

Gresham, Oregon 97030

503-512-1040

Email:

mburke@...