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  1. #1
    Join Date
    Jul 2009
    Posts
    3

    Default Insurance Coverage, Chiropractors and Greed

    My question involves a traffic accident in the State of: California. Irvine area
    In January of this year I was rear ended by a young driver while I was at a stop light. Car obtained $8600 in damage and my son and had some injuries.
    To save monies to all I decided to get treated by a chiropractor I visited 4 times before. Believing I would not have to pay for initial examinations as he knew my pre condition state. Disabled VET. I sought treatment only to be brought back to like condition as I have learned that I cannot be healed.
    The chiropractor gave initial exam and was complaining how someone he knew just stiffed him. like it was my concern. He put a demand that I see a lawyer friend of his which I denied as I have handled a case on my own before.

    I believe he was trying to have lien protection. He then did not want to treat me until he found out that I had Med pay of $1000 and treated it like it was candy. I was unaware of his billing practices. We spoke of claim value and he asked what the damage to my car was and I told him the amount. He said that it would be ok to spend about 4000+. I told him I just wanted to be brought to like condition and to keep it no more than $3300. I asked for statements and only received one somewhat of a bill email with the total to date and was not itemization. As time went on he spoke to me on things he could perform and prices were in line. His dad used to be an Adjuster he claimed. Close to the end of the treatments he asked me what award I was thinking I would get. I said I know things are not like they used to be and was hoping to get 1X to 2X Pain and suffering for medical.

    He said I was lucky to get $1000 (Is he going outside of his medical field?) Well I soon wanted to end this with him. Cut my losses I should have never seen this guy.

    In all he requested that I see him 33 times over 3 to 4 months. Before I stopped I asked him if we were in line financially and he said yes but thought he should see me a few more times. I ended it after one additional visit. I asked him what I owed and he said just about $4100 not the $3400 I requested him to limit my treatment to.

    Well I received Final Bill. A whopping $5020. I called him on it and he said it was correct and in line with what the insurance will pay. I told him it better not affect my bottom line. I turned it in for settlement.

    Insurance claims it is unreasonable high. Soft tissue damage and such and has only budged up offer total to $6000 to cover both medical expenses and pain and suffering. After paying back Medpay and Chiro I will get only $980 for pain and suffering. Insurance will not even pay for millage or time to and from chiropractor.

    A question is there away to determine fair billing of chiropractor? I looked at Medicare rates for CPT codes and offset for OC area and his billing does seem extremely high, but tables may not apply.

    The chiropractor was calling my adjuster more then I was and seem to know what was going on. I told him I was at stalemate and he offered to lower his bill by $820. But is still higher than the $3400 I asked him to be at.

    I have been in stalemate with adjuster and received a call from Chiropractor wondering about the claim and what was happening. I told him I was at a stalemate and he said again said “just how much do you think you will get out of this claim!” I said I might have to get a lawyer and he advised me not to do it as award will probably be the same and I will lose more money. Then

    I suggested a demand that he might lower the bill to what I had requested in the first place. He got angry and said he knew where I was at in my claim and that a lawyer friend worked with the insurance company. He threatens me to small claims court if I paid him anything less.

    Question is it legal for a medical practitioner to give legal advice on this part of the case. Has he performed some type of ethics violation? My health seemed to take the back seat of this whole ordeal. Aggravation maximum!
    I still have yet to date seen an official billing statement. I had a list at the end and had to spend 2 hours to place billing codes with dates. He does not have a lean on my case and no set date was set for payment.

    I now see he billed me twice on same day for same alignment CPT Code for It shows that I received Infrared treatment for 29 visits which I only recall it being done 4 to 5 times and to top it off. He charged 2 times at the end for re-examination when actually there was no difference in the days he claimed these happened from the normal treatments.

    Well if I get sued do I have a chance of heck in small claims or do I just put my tail between my legs. Settle this case and pay him what he over charged me for? Should I get a lawyer and fight insurance company for better offers to satisfy both. Or do my claims seem unfair. Yes I had precondition, I was not pursuing help for financial gain. Just to be in like condition before the accident and pay for reasonable pain and suffering.

    Sorry this is so long.

    Here is what he charged for 33 visits
    Are the values reasonable for southern California? I normally paid this same I only paid this guy $75 to $85 a visit before this accident.

    99204 $200 *1
    99212 $40 *1
    99213 $60 *1
    98940 $40 *4
    98941 $50 *30
    98942 $50 *1
    98943 $35-$40 depending on day *4
    97026 $20 *31
    97014 $25 *9
    97012 $30 *30
    97110 $40 *18
    97112 $45 *7
    97140 $30 *4

  2. #2
    Join Date
    Sep 2005
    Location
    Behind a Desk
    Posts
    98,846

    Default Re: Insurance Coverage, Chiropractors and Greed

    You received the services. You appear to have known what the charges would be. If the other driver's insurance won't agree to pay, and you don't have insurance of your own that covers the difference, the rest is normally yours to pay. You're free to try to negotiate a settlement for a lower amount. If you're sued, you can argue to the court that he agreed not to perform more than $3,300 worth of services, and he can argue his side.

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