Insurance Issue - **UPDATE PAGE2**

[Lisa loves Pooh]

...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.

Has been for me with 2 different major employers. 20 visits per year, period. (Not per event)


Don't know what else to tell you other than one was years before ACA and the current one is after.

 

[Kimberlyann11]

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.

I'm at a loss to figure out what he means by "intermediary". Is that his way of saying billing service? And even if there's a balance for the TENS unit, you should owe that to the equipment supplier and not the chiro himself. If he purchases the units and bills them through his office, that would be considered network and not non.

And I'm sure your insurance company is peeved with the chiro. We hate when providers pull this crap and try to make it sound like it's the insurance companies fault. People hate us enough as it is. I can't count the number of times people go on and on about how horrible their insurance is when it's actually the billers who are screwing up. My mom had to jump through hoops with her local hospital because they are apparently incapable of reading EOBs. After it was all straightened out she loudly declared that she "hates this insurance". I'm all like WTH?

My original advice stands. Tell the chiro to go pound sand.

 

[lsyorke]

Lesson learned, and yes, the chiro should write this off.

In the future do not accept "your insurance "should" cover this". Prior to allowing it to be dispensed, call your insurance and confirm coverage for that item, get the persons name you speak to and a reference number for the call.

 

[Jeff in BigD]

I was experiencing some relief from the visits, but we won't be going back to this guy. No telling when the next insurance "issue" will pop up. Our insurance says he has the option to bill us or write them off, I assume that the units will be billed to us though.

My wife suspects that his end game was to get graphic design work out of me as an "even trade".

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.

PT is the next step - I'm looking to add that to the treatment.

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.

Ugh. I think at that point I would have pulled a quarter, dime & 2 pennies out of my pocket & slammed it on the counter so they'd leave them alone.

We are in the process of trying to get $300 refunded from another doctor - we paid before we realized that we had met our out of pocket. It has been months & my wife is beyond aggravated. Certified letter is going out tomorrow.

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

I'm not sure, but I think they are the TENS 3000. Wow, if those prices are what the units what we should have been charged that really makes me want to ignore any bill we might get from him.

He told my wife that the units weren't covered at all (& were $500 each) & he argued with our insurance that he hadn't been paid for the units even though our insurance rep said she had copies of the wire transfers.

I'm at a loss to figure out what he means by "intermediary". Is that his way of saying billing service? And even if there's a balance for the TENS unit, you should owe that to the equipment supplier and not the chiro himself. If he purchases the units and bills them through his office, that would be considered network and not non.

I think his intermediary is a billing service.

He had the units in his office - whether or not he ordered them for us ahead of time, who knows - however the first time he ever mentioned a TENS unit to either of us, we had one in our hands as we were leaving the office. The insurance company told us that Chiro should have given us the option to purchase in network & not just had us pay the difference OOP for non.

Lesson learned, and yes, the chiro should write this off.

In the future do not accept "your insurance "should" cover this". Prior to allowing it to be dispensed, call your insurance and confirm coverage for that item, get the persons name you speak to and a reference number for the call.

Duly noted. He should write it off, but based on how he was arguing with the insurance rep, I fully expect that we'll get at least get a bill for $170, if not the full $1000+ he claims he wasn't paid.