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  1. #1
    Join Date
    Oct 2010
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    Post Medical Provider Did Not Use My Health Insurance Following Car Accident

    My question involves an injury that occurred in the state of: Colorado
    I was sitting at a red light when I was rear-ended. I went to the ER but still had neck pain and headaches a few days later. I went to see the chiropracter I had been seeing prior to the accident. The chiropractor chose not to submit my claims for treatment from the car accident to my health insurance company (like he had for the previous treatments), but instead submitted to the car insurance company of the person who hit me. Now 4+ years later, following long extensive treatment and surgery, the case has finally been settled. The car insurance company denied the claim by the chiropractor and now the chiropractor wants me to pay out of pocket the full retail rates he charged the car insurance company. My attorney has tried to negotiate with the chiropractor. What are my legal rights in this situation?

  2. #2

    Default Re: Medical Provider Did Not Use My Health Insurance Following Car Accident

    Quote Quoting big8husker
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    My question involves an injury that occurred in the state of: Colorado
    I was sitting at a red light when I was rear-ended. I went to the ER but still had neck pain and headaches a few days later. I went to see the chiropracter I had been seeing prior to the accident. The chiropractor chose not to submit my claims for treatment from the car accident to my health insurance company (like he had for the previous treatments), but instead submitted to the car insurance company of the person who hit me. Now 4+ years later, following long extensive treatment and surgery, the case has finally been settled. The car insurance company denied the claim by the chiropractor and now the chiropractor wants me to pay out of pocket the full retail rates he charged the car insurance company. My attorney has tried to negotiate with the chiropractor. What are my legal rights in this situation?
    Sorry to hear about this. Why did the insurance company deny the claim?

  3. #3
    Join Date
    Mar 2008
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    1,995

    Default Re: Medical Provider Did Not Use My Health Insurance Following Car Accident

    Usually, when an insurance company denies the claims, you sue the insurance company. Why is he negotiating with the chiropractor??

    Yes, it is proper practice to bill the car insurance company, not the health insurer. I heard of cases where after an accident, a patient's doctor would recommend another doctor who would take car insurance and workman's comp claims since he doesn't. Where I am, certain chiropractors specialize in insurance claims and many other doctors do not.

    In fact, I am treated by a chiropractor right now, and I have received inquires from my health insurance asking if it is due to a car accident. Had my injuries been due to a car accident, and my chiropractor submitted the claim to my health insurance, and my health insurer finds out it's due to an accident, they would've stopped my chiropractor from submitting claims, and instruct him to bill the car insurance instead.

    My chiropractor said they might even ask for a refund of monies paid had he CHOSE to bill health insurance.

    One thing I was told is car insurers pay far lower rates than health insurance, and certainly not retail rates, which is why many doctors in my area would not deal with car accident injuries requiring patients to go to other doctors.

    One important point is instead of going to your chiropractor immediately afer the accident, the safer way would be to see a medical doctor and have him recommend treatment by a chiropractor.

    Why is that??

    I was going to chiropractors twice a week and see a waiting room full of workman's comp and car accident patients. I can see that he does a lot of unnecessary treatments and runs the bills up due to low reimbursements.

    In my case, he was upset that my health insurer is not paying for one type of treatment, but pays for acupuncture, So he sent a staff member over with a box of needles asking "where does it hurt"?? I overheard his conversation with my insurer, and I told him I am not about to be punctured by needles just because my insurance plan pays for it, and no doctor had ever suggested acupunture for my herniated disks.

    So I often wonder about bills submitted by chiropractors. It is also possible the insurance company's been scammed by chiropractors.

    Now, one thing you didn't mention is if the car insurance is paying anything for injuries, pain and suffering as the accident is clearly not your fault.

  4. #4
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    Default Re: Medical Provider Did Not Use My Health Insurance Following Car Accident

    Quote Quoting SChinFChin
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    Usually, when an insurance company denies the claims, you sue the insurance company. Why is he negotiating with the chiropractor?
    My guess would be that the lawyer wanted the client to continue to obtain treatment for his injury - if he stopped treating six months to a year before trial, the defense would argue that he was either better or not seriously injured - and, as neither health or auto insurance would pay for the treatment, he offered the chiropractor a lien against any eventual judgment or settlement such that he would be reasonably assured of payment.

  5. #5
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    Mar 2008
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    Default Re: Medical Provider Did Not Use My Health Insurance Following Car Accident

    Quote Quoting Mr. Knowitall
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    My guess would be that the lawyer wanted the client to continue to obtain treatment for his injury - if he stopped treating six months to a year before trial, the defense would argue that he was either better or not seriously injured - and, as neither health or auto insurance would pay for the treatment, he offered the chiropractor a lien against any eventual judgment or settlement such that he would be reasonably assured of payment.
    Good point.

    I thought about the issue some more, and because I believe many chiropractors pad or inflate their bills when it comes to insurance, people should look for consultants whose jobs it is to analyze medical bills. I read in the papers that in one case, some patient treated for a bad accident went through his lifetime limit of $1,000,000, when the $722,000 bill for the accident was presented.

    The patient got hold of a bankruptcy lawyer as the bill bought his total billings with his insurance to $1,250,000 as I recall, he had no way of paying it. His lawyer recommended the bills be analyzed.

    When the hospital was told this, the $722,000 bill was reduced to around $200,000. When reporters asked the hospital what happened, they said they had no idea there was a limit, and hospitals has to bill insurance companies more to cover charity cases.

    OK, another way of saying they were cheating.

    Now, since my boss and I both had herniated disks, are treated by chiropractors, I like to share what we learned in comparing notes dealing with billing issues.

    When my health insurance issued the payment for my first visit, the chiropractor billed about $390.00 for the one hour visit, and my health insurance only allowed $220.00. I showed him the bill and complained that I don't exactly recall him doing all of these things.

    His answer, "don't worry about it, I won't ask you to cover anything the insurance won't cover". The remittance advice clearly says "disallowed, patient to pay". So I said "if you ever ask me to pay for any of these disallowed items, that's the last you'll see of me, and I'll have these bills audited.

    I mentioned that to my boss, and she told me she noticed that her billings run #180.00 per visit, and the insurance paid $90.00, with the rest indicating "disallowed, to be paid by patient". She said the chiropractor said nothing to her for six months accepting the $90.00 allowed payments.

    Then one day, the chiopractor said "when are you going to pay for all those bills the insurance won't cover"?? She was floored. She assumed, as in my discussion with the chiropractor, that he'll just accept what was paid.

    So she threatened to get an attorney, and finally, negotiated with the chiropractor to pay half of the disallowed amounts, which came to about $2,000.00.

    We both concluded that the chiropractor should be alerted at the very top, so there would be no surprises. And I really think my boss' chiropractor wouldn't have pulled that stunt had she questioned the bills early on.

    What does this tell me??

    If the OP's insurance has some issues with the chiropractor, it seems to be one where I myself and my boss had with our chiropractors, i.e the bills are probably inflated with all types of unneeded treatments. Not only that, since the OP was treated previously by this same chiropractor, the insurance is also going to be screaming "pre-existing condition".

    If I was the OP, I would at this late date look for some medical opinion, and ask for all the submitted bills be analyzed.

  6. #6
    Join Date
    Oct 2010
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    2

    Default Re: Medical Provider Did Not Use My Health Insurance Following Car Accident

    The health insurance company did not deny the claim, the chiropractor never submitted to the health insurance and instead went directly to auto insurance company - full retail, inflated rates. Car insurance has denied to pay the bills as excessive and now chiropractor wants me to pay the full retail, inflated rates.

  7. #7
    Join Date
    Mar 2008
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    Default Re: Medical Provider Did Not Use My Health Insurance Following Car Accident

    Quote Quoting big8husker
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    The health insurance company did not deny the claim, the chiropractor never submitted to the health insurance and instead went directly to auto insurance company - full retail, inflated rates. Car insurance has denied to pay the bills as excessive and now chiropractor wants me to pay the full retail, inflated rates.
    Several issues I see.

    First, I think from the insurance standpoint, at least around where I am, it was proper to bill the "car insurer". Whether that is all that should be done is the issue.

    You mentioned you were already going to this chiropractor, so if you continued to see him after the accident, the insurance company has no way of knowing what was due to an existing condition, and what was due to the accident aggravating it, and what new conditions developed. If he just continued treating you, rather than have a medical exam done to determine these issues, is the problem.

    Another problem where I am, a no fault state, is insurers pay so much per schedule to a chiropractor, and anything over and above that he should've discussed with you, and NOT assume the insurer would cover any old inflated bill he came up with. Here, many chiropractors would rather not treat patients under car insurance or workman's comp situations, referring them to places that does.

    Apparently, my chiropractor is one of those who handles car accidents and WC cases.

    I had a business with a slip and fall accident where the customer came after me. He said he wanted his medical bills covered, so I told him to go see a doctor, have himself checked out, and I will cover the doctors bills up to $300.00. My thought was if his injuries run beyond that, I would file a claim with my GL insurance.

    This customer went instead to a chiropractor, had a dozen visits, and bought a bill to me for over $3,000.00 I have no idea if the treatments had anything to do with his injuries, and I have no idea what his injuries are. All I know is he showed up at his chiropractors place, got his treatment, and some inflated bill.

    So I filed a claim with my insurance, and my insurance said "what is this"?? At this point, I told my customer it was in the insurance companies hands. A few months later, the customer, now all upset, said the insurance company turned down the claim and refused to pay.

    After that, he got an attorney who went round and round with the insurance and got paid nothing, and the last I heard, his attorney are not returning his calls. He came by and ask if I can help with the bills. I told him that I volunteered to pay $300 towards a medical exam to find out what his injuries are, not to go to a chiropractor and get inflated bills.

    This is a few years back, and I don't know if chiropractor got after my customer for the bills that my insurer wouldn't pay.

    He gave up hassling me after that, and I'm glad not knowing any more about the matter.

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