Insurance Issue - **UPDATE PAGE2**

[Jeff in BigD]

A couple of days ago my chiropractor told me that our insurance hasn't been paying him, so we have an outstanding balance. We checked our provider statements & everything is showing up as being paid for.

We asked him today & he explained that he's working on phasing out our provider, that he's been using an intermediary company to secure money from our provider but they are telling him that they haven't gotten money from our provider. We didn't get a chance to call our provider today to talk to them, but it seems fishy.

Our provider shows that everything has been paid for, chiropractor says he hasn't gotten paid. Should we contact the intermediary directly or have our provider handle it?

 

[low-key]

seems fishy to me also, I would start with my insurance company

 

[KPeterso]

You definitely need to call your insurance company. Most should be open long hours, so you can probably reach them on the weekend. The insurance should be able to look up the check number for the claims and let you know if the checks have cleared yet. You can then go back to the chiropractor with the additional information on the check dates and amounts.

 

[sasywtch]

Something very similar happened to my guy friend and his dentist. It ended up the company was not paying the dentist all the money (of which the dentist knew). Because he was a preferred provider, guy friend turned him in to Delta Dental. Guy friend gets a letter from the dentist that they are "waiving" what he owes and he's welcome to find another dentist (in....don't come back here).

 

[Happy Snowman]

It happens a lot, it's called insurance fraud and it's rampant with Chiropractors...which is why insurance companies have such limited benefits for chiropractic care.

 

[Lisa loves Pooh]

Do you have the Explanation of Benefits. If not, order them and it will show all the payments your insurance company has made. It would be fraud to collect twice. And your chiropractor should have informed you first that he was phasing out your insurer, whatever that means. I would give then a copy of the EOB and have them deal with it. Sounds like their intermediary isn't doing their job.

Your EOB is your proof.

And we have used multiple chiropractors and have NEVER run into this issue. Generalizing this discipline is wrong.

(My insurers actually have the same limited benefits for Physical Therapists. I guess they must commit fraud a lot as well.)

 

[Happy Snowman]

Do you have the Explanation of Benefits. If not, order them and it will show all the payments your insurance company has made. It would be fraud to collect twice. And your chiropractor should have informed you first that he was phasing out your insurer, whatever that means. I would give then a copy of the EOB and have them deal with it. Sounds like their intermediary isn't doing their job.

Your EOB is your proof.

And we have used multiple chiropractors and have NEVER run into this issue. Generalizing this discipline is wrong.

(My insurers actually have the same limited benefits for Physical Therapists. I guess they must commit fraud a lot as well.)

Not generalizing....it's been an ongoing issues for decades....

 

[Lisa loves Pooh]

Not generalizing....it's been an ongoing issues for decades....

Surprisingly the first mention we have seen on the DIS.
If other posters are correct, then your disdain about chiropractors is noted.

 

[NewRVLady]

I consider them quacks also
(and I bet a great many people in USA think likewise) It doesn't have to be discussed on the DIS to make it factual

Go to a PHYSICAL Therapist if you have issues-they work wonders

 

[Happy Snowman]

Surprisingly the first mention we have seen on the DIS.
If other posters are correct, then your disdain about chiropractors is noted.

Being that the DIS is the be all, end all...

Talk to anyone that works in health insurance--or auto for that matter--they will tell you the same thing...

 

[Kimberlyann11]

You can probably get your EOBs online. If your EOBs show payment, tell you chiro to go pound sand. The issue is then between him and your insurance company. Or his "intermediary" whatever he means by that. (check your EOB for the chiro's name. It sounds like maybe he's billing under someone else's name and tax id, which is fraudulent).

 

[tvguy]

I agree with getting the EOB, show them to the Dr. It's HIS problem to figure out why the money isn't being forwarded to him by the third party he selected.

 

[mnrose]

I had a dermatologist try to bill me for the difference between what my insurance paid and what she actually billed. My EOB showed I owed $10. I sent a check for $10 to the doctor's office, a copy of the EOB, and a note saying that their bill was apparently a "mistake" and I would pay only what the EOB said I should pay.

Got a call from the Dr's office a few days later saying "you are correct."

I still don't know if it was a "mistake" or an attempt to see if I would pay the difference. I'll bet some people do and it's worth it to see who does.

 

[Nancy]

Being that the DIS is the be all, end all...

Talk to anyone that works in health insurance--or auto for that matter--they will tell you the same thing...

No we won't.

Usually benefits for spinal manipulation (chiropractor) are the same as the benefits for physical therapy. I would do as other suggest and contact the insurance carrier first. They can pull check numbers and see if they are outstanding or not. They can also verify the mailing address the checks went to. If he/she has a new biller it is possible they never changed that address with the insurance company...which happens a lot because for some reason they think that computers just see a new address on the claim form and fix it. IF the address is not correct then the biller has to call into the provider services line and get that fixed so checks can go to the right place.

 

[NHdisneylover]

I agree that it sounds like something fraudulent is happening.

I would speak directly to your own insurance company. If your chiropractor gave you anything in writing, I would get a copy to your insurance as well. (and if your chiro is asking for money without having given you a written bill detailing the charges, I would request one)

 

[FlightlessDuck]

The word "chiropractor" and the word "fishy" go hand in hand.

 

[Jeff in BigD]

My wife talked to chiropractor about the outstanding balance, said he wouldn't mention the exact amount, but in the same breath said that I could do some graphic design work to help cover some of the costs.

We cancelled our next appointment & talked to insurance company (they seemed upset about the matter), they verified with intermediary that payments were indeed made.

Both my wife & I were each given a TENS unit - at the time we were told that insurance should cover it. He then told us that the TENS units were $500 a piece & not covered. Turns out that he used an out of network vendor, so our insurance says we only owe $170 total for the units. It would have been nice to know this ahead of time because, you know we live together & could have just shared one unit.

They've been blowing up my phone to get us to set another appointment & while my wife was on the phone with the insurance company trying to get the matter resolved, he sent a text asking if he could reschedule our cancelled appointments for Friday.

 

[Happy Snowman]

My wife talked to chiropractor about the outstanding balance, said he wouldn't mention the exact amount, but in the same breath said that I could do some graphic design work to help cover some of the costs.

We cancelled our next appointment & talked to insurance company (they seemed upset about the matter), they verified with intermediary that payments were indeed made.

Both my wife & I were each given a TENS unit - at the time we were told that insurance should cover it. He then told us that the TENS units were $500 a piece & not covered. Turns out that he used an out of network vendor, so our insurance says we only owe $170 total for the units. It would have been nice to know this ahead of time because, you know we live together & could have just shared one unit.

They've been blowing up my phone to get us to set another appointment & while my wife was on the phone with the insurance company trying to get the matter resolved, he sent a text asking if he could reschedule our cancelled appointments for Friday.

Again....shady practices by the Chiropractor....there was NO reason to give each of you one, nor should he have gone out of network for the supplier. I would return the units and get your money back and then go to a physical therapist for treatment.

...and PT appointments on plans that I see are NOT the same coverage/limits as chiropractic care, ever...might be with some plans but not with the 1000's I see each year.

 

[manning]

It's getting crazy out there. I was in the doctor's office when someone was informed of an outstanding amount. Was pretty persistent about it.

The amount was.... thirty seven cents.

 

[Lisa loves Pooh]

My wife talked to chiropractor about the outstanding balance, said he wouldn't mention the exact amount, but in the same breath said that I could do some graphic design work to help cover some of the costs.

We cancelled our next appointment & talked to insurance company (they seemed upset about the matter), they verified with intermediary that payments were indeed made.

Both my wife & I were each given a TENS unit - at the time we were told that insurance should cover it. He then told us that the TENS units were $500 a piece & not covered. Turns out that he used an out of network vendor, so our insurance says we only owe $170 total for the units. It would have been nice to know this ahead of time because, you know we live together & could have just shared one unit.

They've been blowing up my phone to get us to set another appointment & while my wife was on the phone with the insurance company trying to get the matter resolved, he sent a text asking if he could reschedule our cancelled appointments for Friday.

Wow!

My tens unit was around $100 or so. No filing insurance, all OOP.

Run very far and report the heck out of them.

ETA: we're those portable units or professional? Here is a website with pricing. 2nd site I found and pricing is consistent. You were robbed! http://www.scriphessco.com/shop-by-department/electrotherapy/tens-units/?print=y&mobile=y