I just discovered from my page on my insurance co's website that the chiropractor I've been seeing for the past few weeks is charging for 5 "physical therapy" items per visit. For each of the last two visits/bills there are five different things, one $55 and four more $45 each, for a total of $240 billed to the insurance.
But I am only there for about 10 minutes. On the table getting adjusted for probably about 5.
This seems like fraud to me, but I'm not sure.
Should I confront the doc, or front desk, on my next visit? Or is this just standard ops? Based on what I've read here, he is charging for one standard priced legit visit and 4 fake ones it seems.
BTW, I asked this question in another topic and then found this one and realized I was in the wrong place, sorry 'bout that.
Any feedback would be appreciated. AND I am very glad I found this site too!
Practitioners are allowed to bill for multiple modalities per visit, but there is a time component that must be met. If a manipulation is performed followed by 15-min of a ice packs followed by another fifteen minutes of stim, this is allowed to be billed as 2 units. However, if the stim and ice are applied at the same time for only 15 minutes total, only 1 unit of time is allowed to be billed; therefore only the manipulation + 1 modality can be billed. Also, the therapy must be at least 8 minutes or it cannot be billed at full cost. This does not include the time it takes to perform a manipulation, time to walk down the hall to the therapy room, and time to take the ice out of the freezer and apply to the injury. Only minutes of actual therapy count.
I would complain to your insurance company & write to the chiropractic board in your state stating the complaint. After a while, check to see if the insurance co. made the changes on your record. Often they are too lazy to do anything as they can just raise the premiums to recoup their money. Of course, some bureacrat is doing this, not the official company. I tell folks that if they are getting a massage in a chiro office, to check that it wasn't charged to the insurance under some false code! That is a common thing. If you want a massage, go to a place that just does massages, preferably not a chain(but if you go there, tip very generously as they are paid pauper's wages).
NOTE: I AM NOT A CHIROPRACTOR BUT I HAVE BEEN A CHIROPRACTIC PATIENT
It would appear as if you doctor is billing for services not performed. I would suggest that you first call and speak to a claim representative regarding the billing. I would follow this with a letter outline the issues.
The insurance company may, or may not go forward with the issue. They should request the doctor's clinical documentation. You can also request the same information, especially if you file a complaint with the state board.
Some licensing board will take a hard line with this issue. Others may do absolutely nothing.
You could confront the doctor. He will probably has some excuse about what he has performed, how much he is reimbursed, and how much you pay regardless of what he charges the insurance company.
It is fraudulent billing such as this that results in higher health insurance costs. You sound as if you are proactive, and are willing to take positive action. Please follow through so that these questionable billing practices are identified, corrected, and that the doctor is on notice. Perhaps the board will take aggressive action, investigate, and render discipline. One can only hope.
For all the employee's of DC's who bill procedures that are not done, or up-grade the Medicare or private insurance procedure codes, or-- here is the BIG one, --who do procedures that are not necessary ( since when is any chiro procedure "necessary"? ) there are many new companies out there who want to help you file a civil suit to get the $ back.Now the President and DOJ announced a new initiative to prosecute Medicare Fraud just this week. Seems to me this has been coming for a while. The Insurance Co and the federal government are going to hurt chiropractic income when they shut down as a crime, unnecessary manipulation as a fraud. Insurance Co's have not forgotteen how DC's bill for services/treatments that never stop. So who wants to be a DC today?
There are various types of billing-related fraud, to include:
1.upcoding, which occurs when a health care provider submits a claim for health care services, treatments, diagnostic tests or items which misuse standardized billing codes so as to obtain more money than is allowed by law;
2.submission of a claim for health care services, treatments, diagnostic tests, medical devices or pharmaceuticals that were never delivered to a valid patient;
3.unbundling, which involves billing separately for groups of procedures typically performed together, so that a greater total reimbursement can be achieved than would be received from the group, or bundled, reimbursement rate alone;
4.lack of medical necessity, a fraud where a health care provider submits claims for services, treatments, diagnostic tests, prescription drugs and medical devices that are not medically necessary;
These were written with a view toward medical (MD, DO,PhD)practitioners . However I submit these also apply to common billing fraud , regardless of the "doctor" who issues the bill.
Norah UK: I saw 2 separate Osteopaths who reported hip joint deterioration. I started NSA and i no longer have any hip pain, no low back pain, i previously couldnt stand for any length of time. My posture has dramatically changed and my core strength dramatically im
Aug 6, 2014 19:59:11 GMT -5
Norah UK: improved. This is an incredible healing system and unless you have tried it and given it a full chance then really I dont think you can give a proper informed appraisal. I have found it life changing. I have been given my life back.
Aug 6, 2014 20:02:50 GMT -5
Norah UK: There are good and bad practitioners in all fields. I found a practice with 3 amazing practitioners. Osteopathy by comparison is brutal. This is very gentle and profoundly effective.Many things in life we do not understand. That doesn't mean they cant work
Aug 6, 2014 20:06:47 GMT -5
Successful DC = cheating DC: I read success stories, from patients, but the field as a whole is pathetic! The student default rate of chiropractic is evidence enough there is no demand for chiropractic. Adjustments may help, but are a tool anyone can learn.
Aug 7, 2014 13:47:39 GMT -5
Long Term Chrio Patient : Anyone that's critical of Jesse Jutowitz, has skeletons in his closet. I have had permanent improvement in my spinal condition where all other Chrio techniques did noting but provide temporary relief. I compare him to Galileo. Get with it!!!
Aug 14, 2014 8:08:11 GMT -5
thankful: I thank God that I found a chiropractor who had a wellness plan, and educational classes. As I was adjusted and taught, the ailments started disappearing. Chiropractic care is effective, and at a fraction of the cost of the health insurance system.
Aug 15, 2014 10:39:05 GMT -5
Dissappointed : I have been very disappointed in the quality of life I have been able to provide for my family. Other professions constantly embrace technology which allows them to better service their patients the chiropractor administers try to sell a sub luxation
Aug 15, 2014 10:56:16 GMT -5
Dissappointed : Subluxation 120 years and still searching. The reimbursement in chiropractic is minimal a person better served to obtain a degree in physical therapy state of texas degree physical therapy 28k.
Aug 15, 2014 10:58:59 GMT -5
Dissappointed : Physical therapy would of provided better results than your chiropractic adjustment its manipulation not adjustment another scam.
Aug 15, 2014 11:00:07 GMT -5
thankful: I'm glad that physical therapy helped you. My chiropractor helped me, too. I can now climb stairs, and arise from the floor without struggling or labored breathing. I can go for a walk, and have the strength to exercise. I was able to return to work.
Aug 15, 2014 16:50:18 GMT -5
rachel: I totally do think that ML is a scam! I wrote about it here: http://rachelmsw.blogspot.com/2014/08/maximized-living-scam.html
Aug 16, 2014 16:42:54 GMT -5
Aug 18, 2014 14:52:12 GMT -5
Jacque: Anyone here?
Aug 18, 2014 14:52:21 GMT -5
howard: The 'crack' in a chiropractic adjustment represents a joint that was stuck (subluxation,) and is now moving. When it's stuck, it's irritating, and can lead to problems within the joint and nerves around it. Chiropractors correct those subluxations.
Aug 19, 2014 6:42:58 GMT -5
nmsdc: Subluxations, cracks, and nerve interference are nonsensical marketing strategies chiropractors use to rip off the worried well.
Aug 19, 2014 14:07:45 GMT -5
aches: I think if we were well, we would not be searching for a cure for the pain.
Aug 20, 2014 19:56:22 GMT -5
aches: "Worried well" ? If we were well, we wouldn't be looking for relief from neck and back pain.
Aug 20, 2014 19:59:35 GMT -5
charade: if you think a crack is going to help your condition then you are smoking crack! the only light at the end of the chiropractic tunnel is the train!!
Aug 21, 2014 10:35:27 GMT -5
charade: aches: you misunderstood nmsdc's statement. they rip off the worried very well. read slowly and carefully.
Aug 21, 2014 12:33:19 GMT -5
nmsdc: I mean "worried" well people, who are scared and then ripped off for months or years of "subluxation" treatment when a massage or some manual therapy would do.
Aug 21, 2014 15:32:45 GMT -5