Insurance Companies Causing you grief?
We recently received an email requesting studies/research etc. to verify the efficacy of the Pettibon Wobble Chair. There are some larger insurance companies providing coverage in Washington State who consider this “experimental”. As we gathered this information, we sent a request for information out to several of our instructors. This is one suggestion worth sharing:
“Just because a company arbitrarily decides that a procedure is experimental doesn’t mean that they can’t be forced to pay. But since most chiropractors don’t fight this (or maybe don’t know how) the insurance company saves millions in claims that a certain percentage of chiropractors won’t fight.
For example, virtually every insurance company says that MUA (Manipulation Under Anesthesia) is experimental, but that doesn’t stop us from getting paid. We simply have documentation that the patient’s problem was resolved using our (treatment) plan and once we’ve exhausted the insurance company’s appeal system, we file external appeals through the state of Michigan Office of Insurance Regulations. The OIR is very pro-patient, and they’re decisions are binding. And once an insurance company knows that you’re going to continually take it to this level (which costs them money to fight), they’ll simply pay you without hassle.“
Each state has its own system for external appeal. The Pettibon docs out there should get together and figure out what that system is and consistently use it.
Mark W Morningstar, DC DAASP FRCCM FAAIM
www.michiganwellnessandpainrelief.com
In looking into this specifically for Washington State I was able to find the Patient Bill of Rights , if you are interested. If you are experiencing a similar issue and have found solutions like this for other states, please chime in.
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Comments
Are these procedures and treatments covered by Medicare? Every year I have a couple or more thousand dollars available for physical therapy treatments, and more for prescribed therapy/medical equipment, but I have quit using Physical Therapy to treat my scoliosis because it really didn’t help with/reduce the scoliosis or other problems the scoliosis causes that radiate throughout my body, i.e. cramps in my right shoulder and right calf above my ankle.
Mr. Rodman,
Medicare guidelines stipulate that your physical therapy benefits can only be used by physical therapists or medical doctors. A PT or an MD must be physically present during physical therapy treatments in order for them to be covered under Medicare.
However, many Pettibon physicians use financial plans in their offices to make care extremely affordable. One example is CareCredit, http://www.carecredit.com. You can visit their website and get approved right online in about 60 seconds. Then you can take your card to any office that accepts it and get the treatment you really need at a monthly payment that you can basically choose on your own.
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