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.
nmsdc: Sold PI/WC-whore practice, moved to new state, impossible to restart without scamming people with virtually useless treatments for imaginary conditions like all other DCs in this region of chiro-burned healthcare consumers.
Jun 24, 2014 18:14:33 GMT -5
metasin: So I was looking for chiro forums and found this site. So this is where failed chiros come to cry?
Jun 24, 2014 19:58:35 GMT -5
CR Guest: I have a friend who is debating about investing with ML. Seems like ML spews a lot of BS, but appears to make money. Any past investors on here with good/bad experiences? Did you feel cheated? Were you happy?
Jun 25, 2014 9:02:32 GMT -5
Your Conscience: If scamming people doesn't bother you, ML sounds like a good fit.
Jun 25, 2014 15:16:40 GMT -5
Successful DC = cheating DC: Chiropractic should be outlawed. . .like yesterday. I write my legislators to do just that.
Jun 26, 2014 11:28:59 GMT -5
Successful DC = cheating DC: A nurse, a CNA, an EMT. . .all other healthcare workers make more money on average than a typical DC. Chiropractic is a joke! Look up student default rates of healthcare professions. It is an embarrassment & wake up call that chiropractic sucks!
Jun 26, 2014 13:56:16 GMT -5
Sotak: You guys have some issues that have to be fealty with.....
Jun 26, 2014 21:12:58 GMT -5
nock: If chiropractic is such a failure...then why do people feel get better? Its not like the medical industry is setting the world on fire. Diabetes has gone up over 40% and all the leading killers are preventable diseases.
Jun 30, 2014 11:50:50 GMT -5
whatamistake: Nock.... we're not debating that cracking your back feels good or in your words "gets people better". The issue comes back to quack philosophy behind it, and it doesnt matter what the medical industry is doing because they get paid for it and chiros dont.
Jun 30, 2014 12:41:32 GMT -5
nmsdc: Nock, those are irrelevant appeal logical fallacies. Chiropractic is legislated quackery. Chiropractic is pseudoscience. Subluxation is fictitious, like astrology.
Jun 30, 2014 20:16:55 GMT -5
austinholisticdr: As a Chiropractor I simply take the pressure of the nerves and allow the body to heal naturally from within, using my hands.
Jul 12, 2014 20:24:22 GMT -5
science: austinholisticdr..........prove it.
Jul 15, 2014 13:22:31 GMT -5
person: I have had a few concussions, car accidents, played football over a decade ago...and I can say that I was a skeptic of chiropractic until I was adjusted. I had never been to a chiropractor until I got the job as representing a clinic. I had cysts that...
Jul 15, 2014 13:46:54 GMT -5
person: ...doctors couldn't help me get rid of through surgeries and medicine. They always came back. After 7 or 8 adjustments, the cysts have literally gone away. No site of them, and some of these had been there for a solid year....
Jul 15, 2014 13:48:55 GMT -5
person: One cyst in particular was around my belly button and it was releasing puss very frequently. I went to a general doctor, urologist, and a couple of general surgeons and they seriously could not figure out the cause even after my $550 CT scan....
Jul 15, 2014 13:50:42 GMT -5
person: Take it or leave it, but I feel like a new and healthier person for the first time in forever. No stress, more energy, and no more pain. Not to mention the hit and run accident I was a victim of while on my bicycle (hit by a speeding truck)....
Jul 15, 2014 13:52:06 GMT -5
person: I went to Stanford Medical for my facial reconstructive surgery after sliding 20+ feet on my face with my body in a scorpion position and not once did they take an x-ray of my spine to see if there was any damage. Turns out there was a hell of a lot of it!
Jul 15, 2014 13:53:49 GMT -5
The good guy: The science behind the wobble cushion. It's sound science same as the physical therapies used in traditional medicine. It is part of what they call spinal hygiene. The more you move your spine the more it pumps fluid in it. I have read in many places the w
Jul 24, 2014 18:20:38 GMT -5
LogicalBeing: Movement is an essential component of what defines life and its quality and quantity is measured in chiropractic and simply improved. You don't need science to tell you that if you simply allow yourself to think. Adjustment has been done for over a 1000yr!
Jul 25, 2014 11:58:46 GMT -5
LogicalBeing: 3 yrs late but answering Copernicus DC... once you improve movement you do NOT need to stabilise it!!!! otherwise after every yoga session you'd be sitting in an iron cast suit !! only to cause more restrictions!!
Jul 25, 2014 12:02:44 GMT -5