by johnmajer » Thu Oct 21, 2010 01:56 pm
I have Horizon BCBS NJ. Insurance Rep says $25 co-pay for chiropractic. Whereas Physical Therapy is subject to deductable plus % coverage after that. I went to Chiropractor. He's charging me $25 for his chiropractic work and says the other "modalities" (such as electrostimulation, stretching, etc) falls under physical therapy. Apparently he wants to use codes that fall under Physical Therapy in my incurance coverage. Of course this requires me to pay more than just the $25 co-pay. Is My chiropractor allowed to do this? Is he double-dipping?
Posted: Thu Oct 21, 2010 07:35 pm Post Subject:
Yes, and Yes. Is it a problem, no. It's the standard practice. If you went to your MD and he recommended physical therapy and sent you to a PT, guess what? You'd be paying all those same expenses. It's your choice . . . one office or two.
Posted: Fri Oct 22, 2010 05:59 am Post Subject:
Thank you for the reply. Since it is standard practice for a chiropractor then its my iunsurance company (BCBS NJ) making more $ by splitting my coverages for "chiropractic" and "Physical Therapy". Mind you this is from a single office visit. By splitting coverage like this I pay more out of pocket because I pay the $25 copay for chiropractic care and subject to out-of-pocket expenses for the physical therapy part.
Posted: Fri Oct 22, 2010 07:54 am Post Subject:
By splitting coverage like this I pay more out of pocket because I pay the $25 copay for chiropractic care and subject to out-of-pocket expenses for the physical therapy part.
Understood. But you misunderstand the workings of your insurance plan.
As explained, the benefits available from your health insurance are allowed under two separate provider categories. That they are provided at the same time, in the same place, even if by the same person, really does not matter. In purchasing the plan (or in accepting it as the plan provided by your employer), you agree to the terms under which coverage is provided.
Physical therapy is an entirely different process than a medical visit. The latter is diagnostic, the former is recuperative/restorative. You are attempting to categorize them as the same thing, when they are not. One is covered 100% after a copayment, the other is subject to a deductible and coinsurance.
The discussion is about diagnosing an apple and treating an orange. Sure, they're both fruit, but one is citrus and the other is not. Two different sets of rules apply.
It's like taking your car to a mechanic. He tells you the cost to fix the problem with your car today, let's say it's the alternator, is $150.00. But while taking the alternator out, the pulley falls off the air conditioning condenser pump. He calls you up and says there's another part that needs to be replaced, directly related to the alternator repair, but an entirely different component system, and it will take an extra couple hours of labor and cost an additional $250. You say, "But you told me the cost to fix the car was $150. Now you're telling me $400."
Two different services, same vehicle, same day, same place, same mechanic. Two different charges. You can bet it would cost you more to have the two services performed separately on two different occasions. Not to mention the additional time without the use of your car.
Is the mechanic double-dipping? Well, who's to say he was negligent in removing the alternator and broke the A/C pulley? What was your objective in taking your car to the mechanic? To restore its function. That you end up paying for two different part/repairs at the same time . . . oh, well.
So if you don't like the idea that your DC is billing for two separate services on the same visit, schedule them separately. Nothing will change. The terms of your insurance contract do not change because you have two different appointments instead of one.
But what is the cost you in terms of lost productivity? You'll still pay for two services, under two different terms of coverage, and you'll be out the additional time to attend two separate appointments.
And when it comes to copays, in particular, if you took your child with you to the DC to have their spine "adjusted" at the same time you have your appointment, you would pay a separate copay for your child's visit. Is that double dipping? Two different patients, same policy, same doctor, same office, same time. It's all relative.
I'm afraid you're trying to salvage a soup sandwich here, and your chance of success is nil.
Posted: Fri Oct 22, 2010 04:31 pm Post Subject:
Problem is its still an insurance scam that I believe most poeple will fall prey to.
I call my insurance provider before going to chirpractor. They told me that if i went to a chiropracter (which I did) that the copay is $25. I ask the insurance company if i go to PT than what. They explain how the coverage is different when you go to a PT. I then go to chiropractor (not a PT and not a Chirpractor/PT). I pay my $25.
After I leave the office. The chiropracter uses some "codes" in his claim aganst my insurance company which falls under PT. Mind you I have no idea that this happens as I am no longer in the chiropractor office. How in the world would I know that he is going to use these codes? How in the world do I know that some of these fall under PT. Its ridiculus to say that I should (and in anyway) know thsi by the terms I entered into when signing up for this insurance.
Most if not all people fall to this scam and unfortunately that's why my insurance company does it (to make them more money)
Posted: Fri Oct 22, 2010 07:02 pm Post Subject:
Problem is its still an insurance scam that I believe most poeple will fall prey to . . . Its ridiculus to say that I should (and in anyway) know thsi by the terms I entered into when signing up for this insurance.
You may feel that you are the victim of a "scam", but the truth is, you fail to know and understand what your contract provides. By your own admission, you have not read your contract. In this, you are not unlike most insureds.
But that's to your detriment. People get involved in contracts (and not just the insurance kind) every day of the year, failing to read what they are obligating themselves to or what they are obtaining. In either circumstance, when they end up on the short end of the equation called "ALEATORY" (which means unequal giving and receiving) they think they are being ripped off.
I've done my best, twice, to show you that regardless of how many persons you see or don't see, your policy covers different aspects of health care, including physical therapy, in various ways. You pay a copayment when you see your Primary Care Provider (or Chiropractor). You pay a deductible and/or coinsurance when you obtain the services of a physical therapist. The two services are not the same.
For your $25 copay to see the Chiropractor, you get to be "seen" by that person. When he submits his claim, he indicates what services he provided to you. The insurance company evaluates those billing codes according to your contract and makes its payment as required by the contract.
Physical Therapy does not have to be performed by a licensed PT. Your Chiropractor's "DC" allows him to perform those same services. Your insurance is making its payments based on the service you received, not the provider specifically.
If your Chiropractor had said, "Now, John, your insurance doesn't cover physical therapy in the cost of the office visit," would that have changed your mind about what's going on?
Your Chiropractor may or may not know how your insurance covers various claims. It's not his responsibility to bill in the manner that is most cost-effective for you, but to bill according to the actual treatments or services provided. He is probably not going to be an expert in insurance contracts, either.
Most if not all people fall to this scam
Again, there is no scam. If you think there is, then you should file a complaint with the state regulator and see what they tell you.
In the meantime, I recommend that your spend some time reading and understanding your insurance contracts -- life, health, home, auto, business (as applicable).
Posted: Fri Oct 22, 2010 07:58 pm Post Subject:
I have read all contracts that I have signed with this insurer. I even have asked for them to send me all info regarding my policy coverage (of course this is of no easy task as they fail to send numerous times with no repercusion). No written language in their policies that I have seen would have allerted me to this. I'm not a dunmb person. PhD in the sciences.
Its demeaining to say I have to read all insurance contracts, As if i don't do due diligence.
I understand you have to stand up for your side. That's fine.
However I'm sorry that you choose to stand up for this in your own best interst. Its not the best interest of the average american. The average insured american will pay more out of their own pocket because of such insurance policies.
Posted: Fri Oct 22, 2010 09:53 pm Post Subject:
Just because I'm an insurance agent doesn't make me a fan of insurance companies any more than you are, John.
I'm definitely not "standing up" for any side. Just telling it like it is.
What written language are you looking for? "We make you pay double when you go to a Chiropractor and have a physical therapy treatment?" It won't be stated like that. But when you have a discussion about copayments, deductibles, and coinsurance, you can bet that's where the rubber meets the road.
This has nothing to do with being or not being in anyone's "best interest" or how much someone pays out of pocket. It is merely one insurance company's method of paying or not paying claims. Are there other insurance companies that cover situations like you've described differently than yours? Perhaps.
You're in NJ and I'm in California. The demographics here, with nearly 39,000,000 possible insureds are very different than where you are. Market forces often dictate what insurance companies choose to do, or not, rather than the law.
For example, Medicare Advantage ("Part C") plans here in Southern California provide far better benefits than Original Medicare ("Parts A & B") ever will, and do not charge a premium over what people pay for their Medicare coverage (mostly only a Part B premium) -- and, for 2011, they're now advertising no copays, no coinsurance, no deductible, no out of pocket expense for some elements of coverage. But in Vancouver, WA where my mom lives, there aren't nearly as many old folks, and so she has the privilege of being charged $90.40 per month (but I pay it for her) on top of her $96.40 Part B monthly premium -- plus copays, plus drug costs. Is that a scam?
Not at all. It's just the price of doing business in a particular part of the world. And you're paying a particular price for specific services for living in NJ.
But don't worry, if there are no substantive changes in the legislation affectionately referred to as "Obamacare", come 2014 and later, we'll all be paying far more for the coverages we have courtesy of a Congress and President who created, voted for, and signed a piece of legislation whose real intent is to put health insurance companies out of business.
And when the last one leaves the playing field, as the result of not being able to operate at a profit, and all we're left with is the US Government -- which has no concept of "profit" -- to pay our bills, you can bet you won't be going to the Chiropractor for $25. And you will pay a second charge -- or maybe even the full cost -- for physical therapy.
And much higher income taxes for the privilege.
Posted: Wed Oct 31, 2012 01:41 am Post Subject: i'm being charged two copays
My chiropractor office is doing something similar with me. I see a chiropractor who also specializes in active release technique and mechanic traction, both of which are not used on me. the front desk guy claims because my chiro specializes in those things that i can be charged for physical therapy services. the only procedures that i have received that did not involve cracking my spine was electric stimulation pads on my back and some shoulder rubs, yet i am still being charged a physical therapy copay in addition to the chiropractic copay. my chiropractor even told me that i should go see a physical therapist, so why must i pay a PT copay there if i'm not receiving actual PT services? i spoke with my insurance company today and was told any pt procedures the chiropractor performs would be covered under my chiropractic copay.
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