Food for Thought 2003 - Insurance

G. Douglas Andersen, DC, DACBSP, CCN

Volume 21, number 5, 2/24/03, page 26
Examples of how insurance companies play games.

Happy 03! Shortly after graduation while job hunting, there were two statements from established chiropractors I once knew that were so disturbing, I will never forget them. The first one told me, “It’s a license to steal.” The second one said, “Everyone who walks in your front door should be worth at least $2000.” It was clear they both were exploiting the insurance industry. I thought to myself I would never have the problems they do with insurance because my patients will either get better or get referred.

I started practicing in 1986. Insurance companies paid my bills on time and in full. The occasional delay or denial was usually resolved rapidly. I treated them fairly and they reciprocated. The overall treatment was fair. That year I went to my first (and last) big chiropractic practice building seminar. It was three days long and full of the most mindless, embarrassing, patronizing dogma I had ever heard. One practice builder told us, “They come in hurt, you treat them ten times over the course of a month, they get better and now they’re walking out of your office. What are you going to say when a patient with thirty visits and eleven months is leaving your office?” Needless to say, asking the patient to call when they or someone else needs me was not what he wanted to hear. At this seminar, the lowest form of life was a “pain doctor” (yours truly). It was my initial exposure to the wellness concept and the techniques they taught to capture those unused visits. I thought then and still do now that billing insurance for this type of “treatment” was unfair, wrong and something I would never do.

After writing last year’s Food for Thought article - “How to Pick a Chiropractor,” many of the hundreds of emails I received contained statements like, “I know you are receiving tons of hate mail, so I thought I’d just write to let you know I agree with you....” What would be a great surprise to many of those who wrote (both pro and con) was that a full 50% of the responses I received were positive. This brings me to this year’s topic.

Memo to the Insurance Industry

There are plenty of chiropractors who do not overtreat, overutilize, or overbill. They don’t like chiropractors who do any more than you do. I personally applaud all the tactics you use to make their life difficult and I am guessing many of those chiropractors who agree with my ideas would feel the same. However, you HARM YOURSELVES, YOUR POLICY HOLDERS, AND THE WRONG CHIROPRACTORS by assuming everyone is out to get you. You (the insurance industry) should do everything you can to treat legitimate chiropractors and their patients fairly. You know who they are because you have their practice profiles. And, in the cases where a profile is out of the norm, you know how to investigate to find out whether the practitioner is legitimate or not.

The following is an example that could undoubtedly be multiplied many hundreds of times by many chiropractors; Last year, I had a patient enter my office who had been injured in an automobile accident. He was treated on five occasions and responded very favorably. He was released with a total bill of $580. The insurance company did not pay my bill. My office made numerous calls, and sent eight statements. Finally, after four months, we received a check for $360. My office manager called and was told we overcharged the insurance company. (As an aside, she will often tell her family, friends, and patients, “Before I started working for Dr. Andersen, I had no idea how poorly insurance companies treat doctors.”) I then had my receptionist call, wait through the voice mail, go through the screeners and finally get a supervisor on phone. I then picked up:

Dr. Andersen: Do you think many chiropractors treat people too long?
Insurance Company: Yes.
DA: Do you think many chiropractors treat people too many times?
IC: Yes.
DA: Do you think many chiropractors charge too much?
IC: Sir, what is this? Sir, please get to your point.
DA: How many 30 mph rear end accidents into a stationary vehicle have all injuries resolve in under 30 days?
IC: Aaaah, not many.
DA: How many moderate impact cases resolve with less than ten treatments?
IC: Not many.
DA: How often is a bill for this type of accident less than $600?
IC: Rarely.
DA: Then why are you punishing me for resolving an injury in less than 30 days with fewer than 10 treatments for a fee of less than $600?
IC: Your charges exceeded usual and customary.
DA: What is reasonable and customary?
IC: That is information we cannot disclose.
DA: Then I must ask you, WHAT DO YOU WANT? You just complained about excessive treatments and excessive billing when I got a patient better for under $600 and you still want to treat me like a criminal and punish me. The reason why the patient got well was (1) he was highly motivated; and (2) he received quality treatment, including a lot of soft tissue work. What would you have wanted me to do? Give you a usual and customary charge of $50 (?) for a pop-and-go and treat him 25 times? I get the feeling you think either 1) every patient magnifies his or her symptoms or 2) every bill – large or small is padded.
Is that what you think?
IC: No.
DA: Well I sure hope this call is recorded for “quality control”! For everyone who is listening, I don’t like dishonest patients anymore than you do. But the good news is your industry has made this whole process so miserable, most insurance patients I see wait too long to start care because they don’t want the stress you cause.
IC: (long pause)
DA: I do not understand why, when someone does a good job, we still get penalized. I did $580 worth of work and I expect to get $580 worth of reimbursement. Do you expect me to charge $50 for a $100 treatment?
IC: (long pause)
DA: Why won’t you just look at the bottom line which was a much smaller bill with much fewer visits than your statistics dictate for an accident of this type and realize that you are upsetting an honest patient and a good chiropractor?

Five months after the patient was released, the company agreed to pay my bill in full. Question to the insurance industry: How much interest income do you make yearly by stalling on almost every bill you pay?

Here is another example (I have so many it is hard to pick): A woman with neck pain entered my office for treatment and examination. We called the company for whom we were a provider (membership on their panel included a reduced fee schedule) to confirm benefits. One of the questions my staff asked was, would x-rays be covered? Their answer was yes. I then examined the patient and told her, based on my findings, I thought we should be able to resolve her problem in less than five visits. I also told her I was not going to x-ray her unless her response was unsatisfactory. She appreciated my attempt to save her the exposure to radiation. (I also felt the insurance company would appreciate my attempt to save them the cost of x-rays.) After four visits, her improvement was only 20%, so I took an AP and lateral cervical x-ray. (Her problem area was C6-C7.) We saw some DJD at C6 C7 which explained the slow response. After six additional visits, she was released permanent and stationary with full resolution of all pain. Our bill was submitted to the insurance company and was rejected. The reason was that our x-rays were unauthorized. We resubmitted the bill, informing them that we were told that we could x-ray. They gave us a second denial, saying that we were told we could x-ray on the first visit, but since we did not x-ray on the first visit, we had forfeited our authorization to x-ray at a later time without specific authorization. After a flurry of phone calls, we then submitted another appeal. This time, we were rejected because we DID NOT TAKE ENOUGH X-RAYS. The rejection letter stated that if we were going to take x-rays of the cervical spine, we should have taken at least three views. When my staff showed me this rejection letter, you can imagine what my reaction was. We made some phone calls, got through to a supervisor who then transferred me to a staff doctor. I told him my story about how I was trying to save the patient exposure to radiation and his company the cost of x-rays. He then began to read me some rules about the amount of views required. I continued to argue with him, after which he stated that I should write a formal appeal report. I spent the next hour writing the report which we sent in and, lo and behold, six weeks later, finally got paid. Therefore, it was six months before I received payment for an examination, two cervical x-rays, and nine treatments which totaled all of $300. I then quit this company shortly thereafter. When they asked why, I stated that working for substantially reduced fees was already a sacrifice and I simply could not afford to spend the additional time and money required on every single case of every single policy holder to collect the money I earned months ago. I told them I would not blame them if I had seen this patient 56 times for her symptom complex. But it is unacceptable to be jerked around for months on straightforward cases.

It currently takes more labor, more phone calls, more paperwork, more re-submissions, and more appeals to collect smaller reimbursements from the insurance industry. No one likes to be voice mailed, fine printed, stalled, delayed and treated unfairly. I realize that the insurance industry has more money and more power than the healthcare industry. I realize we cannot compete with the money you donate to our elected officials; however, it is this author’s opinion that the insurance industry should take a close look at how they do business. Treating honest patients and doctors like thieves increases both animosity and anger. It creates an environment that breeds contempt and causes everyone to have a “get even” attitude toward your industry.

Finally, when patients see that their premiums continue to rise and the doctors see their reimbursement continue to decline, do you think we believe you when you complain about the increasing cost of chiropractic care? What do you think we say when you cry poor while your profits and reserves indicate the opposite? What would you do if you were a chiropractor (or patient) and the insurance industry treated you like you treat us?

There are many patients and many chiropractors who are trying to do the right thing. It would be nice to see the insurance industry reserve their “usual and customary” treatment to those who deserve it.

A final thought…
Imagine you go to the local market, buy a bunch of groceries and then tell the clerk you will pay what you want, when you feel like it. Payment will probably be less than the bill. You tell them they may need to call, write, fax and email over the next few months or you will forget to send the reduced check (without interest) altogether. Now, is that fair?

916 E. Imperial Hwy.
Brea, CA. 92821

(714) 990-0824
Fax: (714) 990-1917


Copyright 2004, G. Douglas Andersen, DC, DACBSP, CCN, 916 E. Imperial Hwy, Brea, CA 92821, (714) 990-0824