Reminder: Make Sure Medical Procedures Are Covered Before You OK Them

Nick suffers from back pain and thought he’d seek chiropractor care for some pain relief. What he got in return was the sting of a nasty hospital bill because his insurance wouldn’t pay for his x-rays, even though the nurse and doctor assured him the scans would be covered.

Nick writes:

In trying to be a good consumer and help others learn from my mistakes, you guys might want to consider reminding your readers to ALWAYS check health care coverage themselves over taking a doctor’s “assurance” that everything is covered. I say this because today I dished out $280 for X-Rays that I had taken at my new chiropractor’s office. On my first visit I was assured by the nurse that I was covered and again by the doctor when I expressed my concern that my insurance would cover everything since I did not currently have the funds. Like true snake oil salesmen they convinced me not to worry and generally made me feel like my health was the first concern. Upon my second visit I was told that my insurance would in fact not cover my X-Rays and that I owed them $280 for these.

I know that I should not have went to see a chiropractor as holistic/alternative medicine is a farce, but after a decade of worsening back pain I was desperate. Don’t let your desperation for relief take away from your ability to think rationally.

Although Nick’s rage against holistic and alternative medicine seems a little misplaced — most insurances cover chriropractor care — he does have a point about checking with insurance companies before you sign off on any elective procedures. It’s not a great idea to trust the assumptions of medical professionals who may not have the intricacies of every health plan of every patient committed to memory.

Of course, now that the doctors will need to get their money from Nick rather than the insurance company, Nick can try some haggling to tip things in his favor.

(Photo: Evey Wiechert)

Comments

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  1. deadandy says:

    Did you know that some insurance companies have a disclaimer that just because their phone rep says something will be covered, it might not actually?

    I ran into this recently. I wanted to get my 14-year-old daughter the HPV vaccine. I checked my benefit page (this is BCBS) and it read that only women 17 and older are covered for this vaccination. I thought this odd because it is recommended for girls to get it much younger (it helps prevent cervical cancer among other things). So, I called, and the rep told me it was a mistake and that 17 and older are actually NOT covered. So I got the vaccines, and subsequently received bills totaling hundreds of dollars from the clinic because BCBS declined the charges. After I called back, I found out about this disclaimer. Apparently they are allowed to tell me something is covered when it might be denied.

    I will fight this to the death, BTW, on principle if nothing else.

    • Tux the Penguin says:

      @deadandy: An insurance company can have that policy, but it won’t stand up. If I call my company, I am speaking to an agent of the company. If they claim that something is covered, the company must abide by the agent’s contracting.

      That’s the core of it.

      Granted, you’d have to go through arbitration, have proof you were told that (such as maybe calling while on speaker phone with the doctor there) and then a bit of luck to get through it.

      • Tim says:

        “@deadandy: The lease for my apartment has a clause that basically says “if anyone told you anything verbally, and it’s not in this contract, it’s void. I always thought it was a weird CYA kind of thing …

        • CaffiendCA says:

          @TCama: With written contracts, actually that’s the norm, the four corners rule. When parties have a written contract, that trumps any oral arrangement otherwise stated.

          See [www.law.cornell.edu]

          • dragonfire81 says:

            @CaffiendCA: the problem will be you have no proof that the agent actually told you that unless you recorded the call, with no call, you have no case. A lawyer might able to subpoena the call recording, but the company could get around that by either claiming they don’t record all calls, only a sample for QA purposes, or saying they delete their call records after X number of days and your call is no longer on file.

            • deadandy says:

              @dragonfire81: Luckily for me, and unluckily for them, I record all calls I make to customer service agents and advise them at the beginning of the call that I am doing so.

          • wrjohnston91283 says:

            @CaffiendCA:

            I deal with written contacts, and they have a section where those signing must put anything that influenced their decision that’s not in the contract in writting, or write word “none”. Basically to prevent the who “well he told me i would get a 10% discount even though i signed a contact stating 5%.

          • kaceetheconsumer says:

            @CaffiendCA: And presumably letters written after the fact too, because we’ve had situations where we’ve received a letter of approval from insurance for a requested procedure only to have them come back six months after the procedure with some clause trying to retroactively deny.

          • H3ion says:

            @CaffiendCA: You can amend or modify a written agreement by a subsequent oral agreement and it is enforceable. For real estate transactions, almost everything has to be in writing. The URL you posted deals with sales of goods.

    • floraposte says:

      @deadandy: Because of The Consumerist, I’ve got a phone log document; I record date, time, name of CSR, and key aspects of the conversation whenever I call anybody over money or contractual stuff.

      I’d also consider it well worth the time to be persistent about this with the insurance company, if you can. In my experience, charges can go away if you don’t back down.

      • dragonfire81 says:

        @deadandy: Good policy, but not airtight. I guarantee the company would try to claim you doctored/misrepresented/fabricated the call (i.e. you and a buddy recorded a fake customer service call and tried to pass it off as real to get the company to make good on something).

        When I was at Sprint, a Supervisor told me this very thing when I had a man on a call playing back a recording of another rep promising a credit that wasn’t honored. My sup told the guy since there was no way to verify the recording, he wasn’t getting his credit.

    • Anonymous says:

      @deadandy: This sounds alot like a situation I’m going through with my insurance, LifeWise. I called to make sure an orthopedic specialist would be covered and I was told yes three times, and the rep even explained to me how the visit worked with my policy. So I’m currently disputing the $500 bill I received from my doctor. If anyone has any advice I’d love to hear it.

  2. Landru says:

    Nick should threaten to file a complaint alleging fraud. Because that is what is was. I’m sure they knew full well the insurance company wouldn’t cover it. How could they not know?

    • floraposte says:

      @Landru: I’ll agree that the medical staff shouldn’t have said anything, but I don’t agree that they would have known. There’s no particular reason for most medical personnel to have any idea what insurance covers, because they’re not usually the ones dealing with the insurance company.

      I’m surprised that administration isn’t stricter about them shooting their mouths off with such things, in fact, because they’re so often wrong–in both directions. I’ve had medical staff insist that a treatment wouldn’t be covered when I had specifically verified that it would be; if I were more credulous, I would have done without necessary care thinking I couldn’t afford it, and I bet a fair amount of people had.

    • DrGirlfriend says:

      @Landru: It’s likely the chiro’s office didn’t actually check the benefits with his insurance company. Because x-rays are usually covered, they probably just assumed it was.

  3. John Gage says:

    I would definitely take this up with the provider. If the provider is part of the insurance company’s network they may have to eat the charges, unless they had the member sign something ahead of time stating that the member knows the services are not covered but will pay for them anyway. (Doesn’t sound like this happened)

    Here in MN, the provider can’t just give the member a blanked waiver either. They have to be specific in which charges they are signing for.

  4. Bellatrixie says:

    “Claims are determined when claims are received by the insurance company. A verification of benefits is not a guarantee of payment.” That is what I’m forced to listen to every time I check benefits for a patient. Even if a service gets pre-authorized, the insurance can still deny it for all kinds of “reasons.” Their most popular is for pre-existing condition.

    What I would like to know is what the X-rays were denied for. It’s possible that the patient has coverage for X-rays, but not for X-rays done by a chiropractor, or not for X-rays of his back due to pre-existing.

    Also, unfortunately, it is your responsibility as a patient to know what your benefits are, like he says. I call as a courtesy for patients, but I am not required to.

    • Eyebrows McGee (now with double the baby!) says:

      @Bellatrixie: My favorite pre-authorization EVER was for my baby, when the insurance company sent me a letter stating that they had examined my case and decided that giving birth was, in fact, a necessary medical procedure and I would be allowed to go ahead.

      I was like, “THANK GOD, because I don’t think he’s going to stay in here past his sell-by date!”

      • Kd McEntire says:

        @Eyebrows McGee (now with more baby!): I laughed so hard at your “THANK GOD, because…” that I got water up my nose. Ouch!

        I’m actually in a debate with our insurance company right now over my pregnancy. I want to try for a natural birth – waterbirth/hypnobirth with a doula/midwife – to avoid pain medication. Instead my insurance company is telling me they WON’T cover it unless I’m
        1) in a hospital setting (which I can understand and am willing to negotiate with them on)
        2) with an OBGYN only (still trying to find one that will allow a waterbirth) and
        3) with the epidural, pitocin, etc.

        This drives me batshit crazy. All my research on Pitocin says that it does TERRIBLE things to your body and interrupts the natural release of endorphins so not only is your birth longer and more painful it starts a cycle of complications that could drive you into having a (more expensive) C-Section.

        It’s enough to make me want to scream. Or, you know, just go have the baby in a field somewhere and take it to the ER afterward, claiming that I couldn’t get a ride to the hospital in time.

        • corellia40 says:

          @Kd McEntire: Is the plan that you’ll be induced? Because doctors CANNOT give you pitocin unless it is a medical necessity to induce labor – it’s against FDA regulations.

          Epidurals are also optional – I’ve never heard of an insurance company requiring pain medication for childbirth. Usually, the nurse who is with you during early stages will ask whether you want one, either just after you’re admitted or when the timing is appropriate to start it.

          Good luck with getting the water birth! Instead of a hospital, check to see if there are any birthing centers in your area, and if your insurance will cover it. They are a hospital setting, usually a midwife attends but there is an OBGYN on call or supervising. If there’s one near you, maybe that’s a compromise your insurance company can live with.

        • Eyebrows McGee (now with double the baby!) says:

          @Kd McEntire: Yeah, the pictocin shouldn’t be routine and the epidural is optional. If you’re in a hospital, there’s going to be an ob/gyn attending regardless. (In my state, midwives are supervised by ob/gyns, so you can HAVE the birth with a midwife but there will be an ob/gyn name on stuff somewhere because she’ll be affiliated with an ob/gyn practice. That may be all your insurance company is asking for.)

          I gave birth in a state where it’s illegal for medical practitioners to attend home births, and in a part of the state where there are only traditional hospitals, no birthing centers. It was still pretty granola and around half the women go medication-free. The rooms at the hospital were reasonably homey and all the hospitals in my area provide natural child birth support and classes. And I don’t exactly live in hippie central. :) Rooming in was available everywhere and breastfeeding was heavily pushed.

          I ended up having a C-section anyway because my baby turned breech at the last minute.

    • kaceetheconsumer says:

      @Bellatrixie: My PPO refuses to discuss claims issues with patients, and the insurance company says they cannot verify coverage until contacted by the provider.

      So sometimes we CAN’T check ourselves.

      • Bellatrixie says:

        @kaceetheconsumer: And sometimes, when I call as a provider, I’m told that I have to check with the patient for the “details” on their policy.

        Insurance is a gamble and the house always wins.

        • DrGirlfriend says:

          @Bellatrixie: I know, I love it when I ask how much of the out of pocket max is met, and they tell me that the patient has to provide that information. Riiiight.

          (Oh the joys of insurance verification.)

          • Eyebrows McGee (now with double the baby!) says:

            @DrGirlfriend: You guys are actually making me grateful for my insurance that, while it remains pretty byzantine, does NOT make these things impossible to find out!

  5. Nicole Jordan says:

    So is there any way to find out for sure if a procedure is covered if you can’t even trust the phone rep? I’ve always found that BCBS tries their damnedest to make their actual printed policies as confusing as possible.

    • floraposte says:

      @Nicole Jordan: I don’t think there is a “for sure” in insurance, but if you can’t find the procedure in the documents, I’d get the word of several phone reps and keep records.

    • DrGirlfriend says:

      @Nicole Jordan: The best bet is to get the provider to give you the procedure code for whatever it is they are doing to you (also known as the CPT code) and give it to the rep, along with where you will be having the procedure done (dr’s office or hospital or chiropractor, for example). Also make sure they tell you if an authorization or referral (or both) is needed, and if it is in place.

      Insurances like to deny based on things like lack of a referral, or that they cover the procedure but only in certain settings, or that a certain diagnosis isn’t covered. Things like that.

  6. serreca says:

    The whole insurance industry gets me so steamed every time I deal with them.

    Why the hell do I have HEALTH insurance if they won’t cover everything I need related to my HEALTH?? Why do I have dental insurance when I am constantly getting bills from my dentist for amounts the insurance won’t cover?? It is infuriating.

    And as an aside, my mom swears by her chiropractor. She has had chronic hip/lower back pain that they have pretty much helped her get rid of.

    • AldisCabango says:

      Thank God We have Saint Obama to save us from this mess. I hope you noticed my sarcasm.

    • Kd McEntire says:

      @serreca: I (heart) my chiropractor big-big. I put my pelvis out of place five years ago and it was so painful I was crying in pain for (quite literally) a week. Then a chiropractor friend of my hubby’s took a look, told me that it wasn’t in fact lower back pain, it was my pelvis, and fixed me up in three minutes. Now when I have a week of bad headaches or a sore back I always go to the chiropractor first to see if it’s something I should go to my regular doctor for or if I’ve just been sitting wrong again (I slouch a LOT) and put bad pressure on the wrong nerves/muscles. Eight times out of ten a five minute visit fixes me right up.

      I think a lot of it has to do with making sure you get one of the good chiropractors, the ones who will say that their method isn’t good for *everything* but what they’re good for works well. Some of them think that if you stub your toe you need to come in and have work done. X-P

    • feckingmorons says:

      @serreca: You have car insurance; do you expect it to cover oil changes?

      That is the problem with the understanding of health insurance today. People don’t think of it as insurance for the unexpected catastrophic illness or injury, its original intnet. Remember those 80/20 plans with a 500 deductible?

      Now people want everything covered as is if were prepaid legal or some crap like that.

      If the contract does not say it is covered, it is not covered.

      • serreca says:

        @feckingmorons: Oh is it that simple? God, I’m so stupid! Thanks for enlightening me!

        It is a big problem when health care is unaffordable, even for those WITH insurance.

        And another problem is how seemingly arbitrary the rules are. They’ll cover certain things, but not others. Or they’ll only cover a certain percentage of the cost if it’s over what they deem to be a “reasonable” price.

        It’s all just so ridiculous.

        • kexline says:

          @serreca: Argh, “reasonable” fees. When I had my first root canal, my insurance company was in Alabama, using reasonable & customary fee tables that hadn’t been updated in at least 10 years. (Not exaggerating.) I live in a big city, NOT in freakin’ Alabama, and paid about 75% out of pocket even though my dentist was in-network.

          I guess I’m paying for 75% of my braces through my current insurer, but damn, at least that’s an elective, non-emergency procedure.

        • ohenry says:

          @serreca: I’ll go ahead and defend the arbitrary part of the contract. That’s really what insurance is for. In terms of what things they cover, they can be as arbitrary as they want. You’re really playing by their rules when it comes to what’s covered, and you’re paying them for that set of coverage.

          I agree with you, though, that with both health insurance and health care being so expensive, it should be easier to understand the policy, as well as easier to have more options.

      • kexline says:

        @feckingmorons: Okay. Dude. If I could trust my insurance to cover major illness and catastrophic injury, I wouldn’t say a word about my $50 copay. (My copay is actually above retail for at least one of my providers, just to give you an idea of how out-of-whack it is.) I can’t trust them to do that. I have to go through an inpatient surgery later this summer, and I am terrified. 10% terrified of anesthesia and medically resistant infections and hospitalitis in general; 90% terrified that my insurer will not honor their obligations, or that the provider will lowball the estimate and then find me liable for thousands of dollars extra, or something else awful I haven’t even thought of.

        If you could trust the insurers to cover major medical, if that’s what insurance was for, then insured individuals wouldn’t be forced into bankruptcy by medical bills related to major injuries or illness. And they are. Often.

        The insurers aren’t adequately covering major medical, and they aren’t doing much for minor and preventive care. What are they doing?

  7. PencilSharp says:

    At the risk of turning up extra-crispy…

    Quite frankly, I don’t believe the doctor’s office should shoulder the blame alone here. Consider: this office probably has to deal with a dozen insurance companies, each with their own coverage levels, deductions, co-pays, etc. Now, the nurses who typically handle these things know what is generally covered, and most insurance companies will cover X-rays in some form, but not usually elective procedures.

    Does this suck? Yes, yes it does. But is it that nurse’s fault that she doesn’t know all the intricacies of your policy? No, no it is not.

    That, Nicky boy, is your responsibility. And while we’re at it, Nick, let me explain something about most health insurance policies: they will never cover elective anything unless your primary provider (the general practitioner or other doctor you see most often) recommends it. Yes, that also sucks, but seeing how high costs have become with that restriction in place, imagine what costs would be like if 300 million hypochondriacs went to a specialist (like a chiropractor) without it…

    • ryatziv says:

      @PencilSharp: Let’s not get all authoritative when you don’t know what Nick’s plan is. My HMO plan, for example, allows me to go to a chiropractor without approval from my PCP.

    • Kd McEntire says:

      @PencilSharp: I was with you until you started blaming the OP so strongly. I agree that you shouldn’t always blame the doctor’s office. But in situations like this, where the insurance company might say one thing and do another or the doc thinks the insurance will cover it because they’ve covered for other patients before or whatever, the best solution isn’t pointing fingers, it’s working out a reasonable payment plan for services rendered and taking away a lesson about double-checking with the insurance company whenever possible.

    • kexline says:

      @PencilSharp: Simmer down there, jeez. Even the OP seems to blame the OP.

    • DrGirlfriend says:

      @PencilSharp: I absolutely agree that the patient always, always should check with his or her insurance to understand their coverage. But the chiropractor’s office was foolhardy in not checking.

      The nurse doesn’t check benefits, the office staff does. I work for a large hospital and verify coverage for almost 1,000 patients a month – I am sure the staff at a chiropractor’s office can verify their patient’s coverage individually. Not doing so reduces the chances of being reimbursed from an insurance company – and whenever possible, you want that insurance to pay, because it’s a lot harder to get payment in full from a patient. And in fact, I catch a LOT of doctor’s offices not verifying benefits properly, or getting pre-authorizations when they are supposed to. I can’t even begin to imagine how much money I have secured in payments from doctors, when it should have been their staff who secured it.

  8. johnva says:

    Although Nick’s rage against holistic and alternative medicine seems a little misplaced – most insurances cover chriropractor care – he does have a point about checking with insurance companies before you sign off on any elective procedures.

    I’d just like to point out that the fact that insurance covers something is not even close to evidence of its legitimacy or efficacy. A lot of insurance companies love alternative medicine because it’s cheaper than real medicine, and they know that offering it will divert some people from going to doctors and towards cheaper alternatives (which is fine if you aren’t really seriously sick in the first place, but not so great for something serious). Keep in mind that the insurance companies’ goal is to save money on claims, not promote your good health.

    Chiropractic for back pain only is a little more legitimate than a lot of alternative medicine, but there is a LOT of snake-oil alternative medicine. Don’t assume it must be proven just because your insurance covers it or promotes it.

    • rpm773 says:

      @johnva:

      A lot of insurance companies love alternative medicine because it’s cheaper than real medicine

      I was kind of thinking $280 seemed low for an Xray, at least compared to what I’d think the hospital would charge.

      • johnva says:

        @rpm773: Definitely quite cheap, but probably because it was done in an outpatient setting. They probably didn’t approve it because they don’t think chiropractors doing X-rays is medically necessary. I would tend to agree.

      • Michael Smith says:

        @rpm773: the last time i had a hoispital xray, the bill was something like $28.

        • johnva says:

          @Michael Smith: Wow, that is really cheap. I can’t imagine that that’s anything more than a 10% coinsurance or something.

          When I broke my arm a couple years ago and needed several rounds of X-rays to monitor its healing, I think the bill to insurance was something like $1800 for conventional X-rays alone (the percentage I paid was much less, but a lot more than $28).

  9. Tom Castle says:

    This advise is a bit overrated. At least in Ohio, the ONLY determination of benefits that matters is the one made by your insurance company AFTER the bill has been received by them – that is, AFTER the procedure has been performed.

    In fact my battle with CIGNA was covered on consumerist.com a couple of years ago before Ben banned me without warning for saying “yawn” one time, and what I learned then, from the Ohio insurance commission, is that predeterminations of benefits are non-binding. Which means it’s not even really insurance, it’s a guesstimate. You can get a favorable pre-determination prior to a procedure, but if your insurance company changes its mind after the fact, you’re stuck with the bill.

    By all means, call and get a predetermination for all procedures, but don’t be fooled into thinking you’re protected against the risk of non-coverage. You’re not. Health insurance companies are scum.

  10. Tim says:

    I’d recommend Nick try to talk it out with the chiro to get the payment reduced. I’m not sure how well it’ll work, but it’s worth a shot.

    Also, I highly doubt the chiro deliberately deceived him into thinking that he would be covered when they knew he wouldn’t. In my experience, medical providers like insurance much more than they like trying to get money from patients.

  11. Anonymous says:

    A lot of people don’t understand health insurance. Many factors go into whether something will be covered.
    1. Is the service covered by the plan? For instance, some plans cover fertility services, some don’t.
    2. Is the service covered out-of-network? Some services may only be covered if contracted providers bill for it.
    3. Is the service medically necessary? Even if a plan covers x-rays, it won’t cover them if they’re not needed in the opinion of the doctor at the insurance company.
    4. Was the service pre-approved? Some things, like appendectomy, may only be covered if the insurance company approves it ahead of time.

    Those are the biggies but there are other issues. Is other insurance involved say in a traffic accident? Did the patient leave the hospital against medical advice? Was it a true emergency? &c.

  12. kduhtoe says:

    Have you considered physical therapy? Your insurance may cover PT services, and depending on your area, you may find a PT that specializes in back pain.

    This doesn’t help you with your current problem with the chiropractor, but it may help you resolve the trouble with your back.

  13. esd2020 says:

    @deadandy: I would check that this “phone rep’s word doesn’t count” thing is even written into your policy. Because it kinda sounds like the sort of “policy” that someone in the claims department just made up.

  14. John Henschen says:

    I had a chiropractor do the EXACT same thing to me about 10 years ago. After going around and around with the “Doctor” I ended up sending him a certified letter containing the letter explaining the situation, the payment I would have made had it BEEN covered by my insurance, and a barely veiled threat that I would take his ass to court for fraud over this. I may have mentioned newspaper editorials I was going to write and calls to the other local media if he didn’t do the right thing. ;)

    • Brent Woodle says:

      @John Henschen: Explain to us again how it is the Chiropractor’s fault that your insurance didn’t cover the cost of his services?

      • mariospants says:

        @Brent Woodle: Because it’s assumed that the Chiro told John Henschen that his X-rays WOULD be covered and J.H. believed him.

        • Brent Woodle says:

          @mariospants:

          The chiropractor is not an agent of the insurance company and it is the consumer’s responsibility to know that. In situations like this you should assume good faith – no medical provider has an interest in lying to a customer about what their insurance will and will not cover.

          • 1234tu says:

            @Brent Woodle: no medical provider has an interest in lying to a customer about what their insurance will and will not cover.

            Bull – it is a numbers game. if it costs me $30 to do an x-ray – for which I charge $250, and I get ten people whoes insurance won’t cover it but talk them into doing it anyway when I bill it 5 of the people will just pay, 2 of them will raise hell but end up paying, and three of them won’t pay at all, but I will still come almost even on them because I sell their $250 debts to a collection agency for $10 each. At the end of the day I would have made a killing.

  15. Mike Lussier says:

    I recently went to a chiropractor for the first time, and also had X-rays done. However, they actually called the insurance company to verify coverage. Here’s the rub…

    They said yes it is covered, with a $20 copay. But I recently discovered I’ll be getting a bill for an additional $250 (suspiciously close to your amount.) This is my deductible amount, after which these services are covered 100%. Do YOU have a deductible that you have not yet satisfied? I had four Xrays done, and let me assure you that the amount is well over a couple hundred bucks.

    So, my question to you is, did your insurance cover a portion of it? Are you left with a 10% or possibly a deductible you must satisfy first?

  16. shepd says:

    So chiropractors are (medical) doctors now? When did this happen? That’s always been my strongest argument against going to one.

    • Brent Woodle says:

      @shepd: They are not medical doctors but they are medical specialists. Referring to them as a doctor is moreso regarding their education (D.C. Doctor of Chiropractic).

    • mariospants says:

      @shepd: whups I just saw your comment after I added mine.

      Seconded.

    • 1234tu says:

      @shepd: They are not medical doctors but they are medical specialists.

      Yes – they are required to attend a rigorous six month program at DeVry followed by a test that is slightly more diffiult than the GED exam.

    • feckingmorons says:

      @shepd: @Cant_stop_the_rock: What possible good could x-rays do a chiropractor.

      Radiographs are not theraputic, and frankly neither is Chiropractic.

      • Jake712 says:

        @feckingmorons: X-rays are part of the CYA process, that and getting you to sign a waiver that if you stroke out after a neck adjustment it’s not their fault.

        @shepd: I believe this may have been part of the complainant’s problem. He refers to them as “doctor” and “nurse”, probably assuming an authority and level of education that does not exist. This, along with his other assumptions.

  17. Cant_stop_the_rock says:

    They probably made an honest mistake, but that doesn’t change the fact that he probably wouldn’t have gotten the X-rays if he knew they wouldn’t be covered. It would be reasonable to expect the chiropractor to give him a substantial discount on the X-rays. Unless the inaccurate information came directly from his insurance company.

    • SadSam says:

      @Cant_stop_the_rock:

      I had the same thing happen to me at an orthopedic surgeon’s office. Before the doctor will even do an examination they take X-rays as a matter of course. Since I had not planned to have X-rays, I had not confirmed they were covered and questioned whether or not said X-rays were necessary prior to an exam with the doc and as to whether they would be covered, I received an affirmative on both fronts, but of course receieved a $250 bill.

  18. donopolis says:

    Insurance is a shameless scam, that has spread to become a requirement just to get minimum healthcare…

    We don’t have healthcare in this country (USA) we have sick care.

    Don

  19. drkev1976 says:

    As a chiropractor, I am getting a kick out of these replies. Your insurance policy is YOUR policy. It is up to you to know what is covered and not covered. It is not so simple to say, “X-rays are covered”. You need to factor in deductables, co-pays, etc. Also, your insurance company may not be paying because they were taken by a chiropractor. This is discrimination, and your beef should be with your insurance company, not the chiropractor. On the other hand the chiropractor should not have “assured” the patient the X-rays are covered, and just stated the X-rays are required for a proper diagnosis.

    On a side note, chiropractic is a very cost effective treatment for back pain. Several hundred dollars for chiropractic care, compared to up to 100K for the medical alternative of spinal surgery. Although neither will fix all patients with back pain, it only makes sense to me to attempt the least invasive, and most cost effective option first.

    • ryatziv says:

      @drkev1976: Actually, the agreement is between the provider and the insurance. I visited a chiropractor’s office whose paperwork said that they are not an involved party, and I called BS on them. They agreed.

    • meehawl says:

      @drkev1976: chiropractic is a very cost effective treatment for back pain.

      [www.ncbi.nlm.nih.gov]
      “CONCLUSIONS: A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration. This model was associated with greater patient satisfaction but increased total costs.”

      [www.ncbi.nlm.nih.gov]
      “Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.”

      [www.ncbi.nlm.nih.gov]
      “CONCLUSIONS: Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful, although chiropractic may result in a greater likelihood of perceived improvement, perhaps reflecting satisfaction or lack of blinding. Physical therapy may be more effective than medical care alone for some patients, while physical modalities appear to have no benefit in chiropractic care.”

      An osteopath is a medical doctor specially trained in spinal and bone manipulation techniques, as well as other “complementary” techniques usually not sondiered part of the core of allopathy.
      [en.wikipedia.org]

    • johnva says:

      @drkev1976: It’s REALLY disingenuous to compare chiropractic manipulation to a $100K back surgery as the standards of treatment that would be offered by a medical doctor vs. a chiro. It would be more fair to compare it to PT or something (I just went through 10 visits of PT, and it only cost me a grand total of…$40 out of pocket). And the PT I did recently was very effective at treating my pain.

  20. kaceetheconsumer says:

    Patients effectively have no guaranteed way of confirming coverage, because even with a letter of approval for a procedure, insurance can retroactively deny coverage. It has happened to us. It obviously happens enough that California is considering legislation about it.

    I’m in a fun situation right now where I did what due dilligence I could prior to a procedure (given that my PPO won’t discuss claims with patients and the insurance company requires the provider to bill first before they’ll discuss it with the patient), and was told the cost would be X as a portion of deductible. After the procedure, the provider suddenly upped the charge to X+Y. After a gazillion calls, it looks like what happened is my PPO has allowed a third party with whom I have no relationship to add on this extra charge. Again, the PPO will not talk to me. The insurance company says it’s out of their hands. The provider at least agrees that there’s no way this third party should be involved and advised me to report it to the state authorities, which I did, and it’s now in their hands.

    But given such things, really, how the heck are patients supposed to make informed decisions about anything when the information can be changed any time by the other players? It’s like dealing with Darth Vader and being told to pray they do not change the deal any further!

    • ZoeSchizzel says:

      @kaceetheconsumer: Yes, you can do EVERYTHING right (you do your research with calls and website searches; the facility/doctor does everything right and gets an answer from the insurance company with regard to coverage) and you can still end up getting a big bill — on top of the HUGE bill you’re already paying for the insurance in the first place! We’re going through a problem right now with a PPO who claims they are not a PPO even though our insurance has them listed as a PPO. Each insists the other is wrong, and we keep getting an $800 bill. It’s an “are not” …”are too!” scenario in which we cannot participate but are financially obligated at the outcome. It’s insane.

      Can I please just hand my substantial monthly insurance payment over to a non-profit healthcare agency whose only objective is to keep me healthy, rather than giving it to healthcare gatekeepers whose only objective is to make it more difficult (financially and practically) for me to get medical care? It’s like paying a daycare provider to neglect your child — and having them demand increasing amounts of money to do it.

      • kaceetheconsumer says:

        @ZoeSchizzel: Yup, yup, yup. You have my total empathy. This sucks. The profit motive needs to come out of the system. It’s positively uncivilized.

      • floraposte says:

        @ZoeSchizzel: My state’s attorney general does have an office to deal with health care complaints, and I took a very similar problem to them. You might check and see if your state has anything similar.

  21. mariospants says:

    Sorry, is it correct to call a chiroptractor a “doctor” i.e. M.D.? Is that allowed?

    • drkev1976 says:

      @mariospants:

      Yes, a chiropractor is a doctor. Chiropractors are known by “D.C.” Doctor of Chiropractic, not M.D.

      Other professions that are “doctors” but not MD’s include, dentists, podiatrists, osteopaths, and PhD’s

      • 1234tu says:

        @drkev1976: Yes, a chiropractor is a doctor. Chiropractors are known by “D.C.” Doctor of Chiropractic, not M.D.

        Other professions that are “doctors” but not MD’s include, dentists, podiatrists, osteopaths, and PhD’s

        Yeah – but the diff is that a dentist, podiatrist, osteopath, and PhD go to a real university with selective standards. Getting into a chiropractic school is like getting into DeVry or University of Phoenix. It is helpful if the candidate can read, but the most important attribute is the ability to pay tuition. Calling a chiropractor a dr. is a bit like calling the guy who changes your oil at jiffy lube an automotive industry engineer.

      • shepd says:

        @drkev1976:

        And I wouldn’t trust a dentist to do anything more complicated than a root canal, either.

        And a podiatrist is fine by me. I just won’t visit a chiropodist (the “dentist” version of a podiatrist here).

        PhD is fine by me because I’m not going to ask someone with a PhD in history for advice outside their field.

        But for “breaking” my back? MD or bust.

      • ElizabethD says:

        @drkev1976:

        … and veterinarians.

      • Powerlurker says:

        @drkev1976:

        On the other hand, you can also find people with an ND (Doctor of Naturopathy) degree, a degree I would not grant a significant amount of credibility. If I had back or musculoskeletal problems I’d see an osteopath over a chiropractor myself, at least they’re “real” doctors.

        • johnva says:

          @Powerlurker: Yeah, the thing is a lot of alternative medicine practitioners have started using “doctor” in their “degrees” because they know it gives them more credibility with customers. Luckily, the naturopaths (a total joke of a “profession”) have been less successful than the chiros in lobbying state governments to make it legal to call themselves “doctor”.

      • kduhtoe says:

        @drkev1976: I don’t know if this thread is still alive, but would you call physical therapists with a doctorate in physical therapy (DPT) “doctor”?

    • Brent Woodle says:

      @mariospants: Do you call people with Ed.D’s and Ph.D’s doctor?

      • morlo says:

        @Brent Woodle: No, and I doubt most chiropractors even have PhDs

      • johnva says:

        @Brent Woodle: Yes, you can. Many Ph.D. professors and such are referred to with the title “doctor”.

        But a D.C. is not even close to the same high level of degree as an M.D., Ph.D., or even a D.O. In fact I would probably place an RN’s medical knowledge above that of a D.C.

  22. Corporate_guy says:

    Pay it and take the doctor and the nurse personally to civil court to recoup the funds.

  23. KLETCO says:

    I’ve called an insurance company before to ask if something was covered and the response was, “just get it done and we’ll tell you if it’s covered when you submit the claim…” which seems unreasonable to me…

  24. meehawl says:

    Chiro isn’t medicine and isn’t scientific, and so it’s not surprising that medical insurance would not want to pay for spurious tests and procedures ordered by a chiro “doctor”. Why not try to get your health insurance to pay for astrology consults as well?

    • ElizabethD says:

      @meehawl:

      You forgot this disclaimer:

      “In my opinion”

      I don’t get all the hate for chiros here. I have had nothing but good experiences.

      • johnva says:

        @ElizabethD: Whether or not it’s considered scientific is not a matter of opinion.

        • SynMonger says:

          @johnva: Yeah, actually it is.

          Whether it is *considered* scientific is an opinion. Whether it *is* would not be an opinion.

          • johnva says:

            @SynMonger: OK, it’s not really a matter of opinion among anyone whose opinion matters.

          • floraposte says:

            @SynMonger: To be really pedantic, that wouldn’t be an opinion either. It’s a fact that some people consider it scientific. It’s also a fact that it’s not scientific :-).

      • meehawl says:

        @ElizabethD: I have had nothing but good experiences.

        [www.ncbi.nlm.nih.gov]
        OBJECTIVES: This study examined the difference in satisfaction between patients assigned to chiropractic vs medical care for treatment of low back pain in a managed care organization.
        CONCLUSIONS: Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients’ satisfaction.

        Regarding “opinion”, this may interest you:
        [www.ncbi.nlm.nih.gov]
        Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.

  25. SynMonger says:

    My mother is a Chiropractor with a small practice. She handles everything herself, with no C.A.s (chirpractic assistants). First thing she does with a new patient is call the insurance company and find out what their level of benefits are (if any). They’ll tell her how many visits are covered, what the co-pay and deductible are.

    She also tells them X-Rays are usually NOT COVERED. Some plans may cover it, but they are not the norm.

    What also happens is that insurance companies will tell her that things are covered, and then deny it later when the claim goes in.

  26. Thain says:

    I don’t understand the apparent disdain for chiropractic work. In general, chiropractic work coupled with massage therapy (one for the skeletal system, one for the muscular) is MUCH better for you than things like invasive back surgery, and it actually helps restore your body to a state of normality rather than leaving scars that keep you in pain for the rest of your life.

    That said, no, Chiropractic work is not the miracle cure some chiropractors claim it is, but it is good for your body, and a much better first option than most doctors would recommend.

    • floraposte says:

      @Thain: The disdain comes from the fact that chiropractic simply doesn’t demonstrate advantage in any serious study.

      And you’re offering up a straw man in suggesting it’s chiro or surgery, as if surgery were all allopathic medicine had to offer.

    • 1234tu says:

      @Thain: I don’t understand the apparent disdain for chiropractic work

      I don’t understand the distain for retailers who sell extended warranties. Lke chiropractors they make money by making someone believe that somthing which is essentially worthless has value.

  27. greggen says:

    Its been said, but if the staff said it’s covered, then the staff should write off and cover the cost.
    I dont see why this has to be a ‘is chiropractic valid’ discussion, the OP could have just as easily gotten the bogus insurance advice from a dentist or optometrist.

  28. Smashville says:

    @mariospants: You can call anyone a doctor, essentially. I highly doubt Dr. Dre has a license to practice medicine, but as he claims no certifications, he is not treading in any legally dangerous water.

  29. BigSlowTarget says:

    Is there any service other than healthcare where the deal is
    1) we will not tell you in advance what anything costs,
    2) we may not tell you what we provide before it is provided,
    3) we do not guarantee any positive results from anything we do and in many cases what we provide will be useless, incorrect or outright dangerous
    4) you will wait on hand, sometimes in pain until it is convenient for us to provide service. If you make an appointment you will still wait in line
    5) the fees may be so large they will bankrupt you and financially wipe out your family … or be zero
    6) Almost the entire expense is paying for someone else’s time (drugs included – they’re mostly made up of researcher’s time + advertising, its why generics are cheap).
    7) you will have final responsibility to pay any amount we bill but you may not know the amounts due for months

    If anyone came to me with this kind of a deal for anything else I would definitely tell them off. With healthcare its standard. Weird

  30. H3ion says:

    Most medical practitioners, at least for expensive procedures, will make an effort to obtain pre-authorization. The insurance carrier may decide to try to deny payment even with a pre-authorization, but it makes it much harder for them to do so. We’ve generally asked our carrier for written confirmation with a copy to the patient so we all know what we expect to happen. Obviously this isn’t for routine stuff but when the numbers get big, it’s worthwhile doing.

  31. Anonymous says:

    I am the son of a practicing Chiropractor. He has been practicing for 29 years, has expanded and specialized in acupressure, and as a first hand benfactor of his care I am greatly offended an asshat that didn’t bother doing his homework on his own health insurance makes the idiotic association (post hoc ergo proctor hoc) that because a Chiropractor isn’t an insurance claims agent that this field of medicine is bs.

    I hope he gets run over by a van full of x-ray equipment.

  32. mariospants says:

    @mariospants: As far as I know, if you’ve got a PhD (even if it’s in religious studies) you can be called a “Doctor”. That requires a board-certified body of experts who will attest that you have reached a level commensurate with that standard. However, we generally only refer to M.D.’s and veterinarians as “doctor so-and-so” in regular day-to-day life.

    I don’t see how on earth Chiros could possibly be allowed this distinction. They simply don’t have the education – and if they believe in subluxation, they’re literally no smarter than “doctors” 200 years ago.

    • ElizabethD says:

      @mariospants:

      “…if they believe in subluxation, they’re literally no smarter than “doctors” 200 years ago.”

      Umm, chiropractic was founded in the 1890s. Not 200 years ago. Just sayin’.

      • mariospants says:

        @ElizabethD: I know that – my allusion wasn’t as strong because they didn’t kill patients 100 years ago as readily as they did 200 ;-)

  33. mariospants says:

    Sorry, not “no smarter” that should have said “no better”

  34. Bruce Blank says:

    to Pencilsharp:

    The point is not that nurses don’t know the particulars of every policy. Of course that is true. If the staff had said “we don’t know”, when asked about coverage, then it would be Nick’s fault. However he was told, “Yes, you are covered” not once, but twice. As far as I am concerned that relieves Nick of all financial obligation. Medical staff are not obligated to know the ins and outs of every policy. They are obligated to admit it when they don’t know.

  35. SpaceToast says:

    Chiropractors are notorious for being x-ray happy. Nick isn’t the least off-base. I’m just sorry he’s in such pain.

    For a brief primer on the history, current state and efficacy of chiropractic, I’d recommend Brian Dunning’s Skeptoid episode on the topic: [skeptoid.com]

  36. bodymech says:

    I’m a bodyworker (a Rolfer/Structural Integrator, closer to manual osteopathy for soft tissue) and I know we just don’t get much press. Except for that Burt Reynolds movie 8-O. We need better lobbyists!
    Finally we are getting some modern scientific research accomplished..
    Some links on manual medicine for your perusal and amusal:

    [www.fasciacongress.org]
    [www.myofascialpainrelief.com]
    [content.nejm.org]
    [www.fasciaresearch.com]
    [nccam.nih.gov]

    Carpal tunnel from too much time online ;-) ?
    [www.somatics.de]

    In dealing with “classic medicine” keep this in mind:
    [www.consumerreports.org]

    Enjoy,
    Emily D-G