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.
madamca: Oh? Did someone call me an embarrassment? I'm embarrassed I missed it.
Nov 1, 2013 20:30:09 GMT -5
chiro2013: Here is the website for Allison Summers DC, RN, BSN: http://doctorsommers.com/
Nov 2, 2013 19:47:30 GMT -5
Hey chiro 2013: old website of mine - yes I've been a working DC for many years. Stick to the facts. Avoid the witch hunt. Chiros really do eat their own. Reveal yourself chiro2013 why are you still hiding? What are you afraid of? I'm here always out front - an open book
Nov 2, 2013 23:58:12 GMT -5
madamca: I love Dr Sommers!
Nov 3, 2013 21:37:14 GMT -5
dc2rn2013: Warning to all wannabe bloggers attacking me: Your comments are not anonymous and your identities are not shielded from this site. Comments that enter the realm of slander and liable will not be tolerated by this member. Choose your words wisely.
Nov 4, 2013 8:31:00 GMT -5
igotout: I feel like I am missing something here...
Nov 4, 2013 11:18:26 GMT -5
igotout: ok, nm... I guess I should venture a little deeper into the boards first.
Nov 4, 2013 11:26:37 GMT -5
dubious: I C
Nov 5, 2013 2:07:35 GMT -5
Tretinoingel: Hello Guys! I am Alexandra Anderson novel writer, I love to write novels, I have experienced great success after publishing my two books Tretinoin cream and Retin A Cream respectively. I also
Nov 8, 2013 4:17:12 GMT -5
Alicia: The Paleo Recipe Book:[br]Get your copy Now ! : http://bit.ly/THE_Paleo_Recipe
Nov 10, 2013 15:37:30 GMT -5
drquackers: News Release[br]New Book Penetrates Chiropractic’s Veneer[br]Chiropractic Abuse—A Chiropractor’s Lament describes the life of a chiropractic expert and his fight against fraud, corruption, and abuse by chiropractors and explores how media apathy and political co
Nov 15, 2013 9:45:51 GMT -5
healing, finally: A chiropractor has been the only physician in my 50+ years to heal me of chronic illness. He practices functional medicine, in alignment with Rankin/Pert/Lipton/Weil/Northrup. Wake up DCs and hone your message!
Nov 29, 2013 9:53:08 GMT -5
healing, finally: HealthSource and The Joint? Get as far away from them, as fast as you can.
Nov 29, 2013 9:54:02 GMT -5
whatamistake: a chiro is no physician
Dec 3, 2013 12:01:46 GMT -5
nmsdc: Pseudoscience quack chiro = Rankin/Pert/Lipton/Weil/Northrup + "functional med"; which cures nothing
Dec 3, 2013 19:51:15 GMT -5
"Go go go go chiro-practic" : Enter your reply here...
Dec 4, 2013 16:49:55 GMT -5
madamca: "Go Go Go Go chiro-practic"--- we need a commercial and a jingle...and advertisement during the super bowl.
Dec 4, 2013 16:51:55 GMT -5
Jim the DC: I read a lot of crybaby crap here by losers who because they couldn't make it in chiropractic, start slamming the schools and their teachers. These idiots are a minority in the chiropractic field who just didn't have the ability to succeed.
Dec 5, 2013 16:51:50 GMT -5
igoutout: An amazingly professional comment. Way to stay above the fray there, Doc...
Dec 5, 2013 17:54:21 GMT -5