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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Insurer
interpreting chiropractic treatment as 'maintenance'
Feb. 6, 2004
Q:
I am no longer with my employer who provided my insurance
at the time of my car accident. I would like to get
this problem cleared up before I sign the release papers.
I
was involved in a car accident two and a half years
ago. I went to the emergency room and was diagnosed
as having displaced ribs. Since they were not broken
the only treatment was pain medication. I asked the
doctor if my chiropractor would help. He said yes.
My
chiropractor performed electro-stimulation therapy which
helped. My insurance said they cover 25 chiropractic
visits per year. I had this therapy every day for 30
days, then every other day, then two times a week, then
once a week, then every other week. This obviously took
several months. My insurance denied paying this since
I had previously "used up" my 25 visits per
year.
My doctor had recommended that I see my chiropractor
because he considered this therapy as major medical
care as a result of the car accident and said it should
not be considered chiropractic maintenance. He said
he would put that in writing for me. So imagine my surprise
when the chiropractor handed me a bill for $1800. I
have been fighting with the insurance company ever since.
I
have been told I should call the Board of Insurance
but as is the case with most every day people, I am
not well educated in the insurance practice. I would
appreciate any suggestions you may have.
A:
No matter what you present to the insurance company,
they may still interpret your visits to the chiropractor
as maintenance. It is possible they may not cover this
particular treatment for your diagnosis. And it is possible
they may only pay for 25 visits no matter what the diagnosis
or treatment is. A supervisor at your insurance company
should be able to tell you specifically why your treatment
is being denied. Often chiropractic coverage is limited.
If your insurance does pay for more than 25 maintenance
chiropractic visits a year under certain circumstances,
call the doctor and the emergency room and obtain a
copy of your records regarding your car accident. You
also will want a copy of all tests performed such as
x-rays. Also obtain a copy of the chiropractor's notes
from your therapy.
Now
call the insurance company. Explain that you want your
case reviewed and you are forwarding them all of this
material. Ask them for the procedure you have to follow.
If
this review does not result in payment, it is a good
idea to call your local State Board of Insurance. They
can offer you guidance and may be able to arbitrate
your claim.
Also,
some car insurance companies may offer medical coverage
for injuries due to car accidents. You may want to pursue
this avenue.
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