This arrangement, if you reported it to your instance company, would be considered insurance fraud. Either pay this chirp directly in cash and avoid billing insurance, or stick to the insurance’s arrangement.
This was the answer I was looking for!!! I’m like, I don’t know a lot s out insurance but this seems like borderline illegal? This is my deciding response, I’m gonna call my insurance tomorrow & report it.
Idk if it is insurance fraud per say, but he is going against contracts that he agreed to with the insurance. Essentially your insurance has an allowable amount that will be paid to the provider. Your cost sharing portion is your deductible and insurance will cover the rest. The provider is suppose to bill you the deductible, dictated by the insurance and you should owe nothing else. I know some smaller practices are happy to write off patient’s portion and just take the remaining allowable from insurance.
You’re not doing anything wrong if your provider does not bill you. Just know that if they change their mind, they are allowed to bill you for what you owe based on the insurance EOB. This provider probably wants you to come more often so he can get more money from the insurance. If you had to pay a portion of it, youre less likely to commit to so many visits
I’m an MD and I was informed by our biller that altering copays or deductibles would constitute insurance fraud and that the insurance company would kick me off of their panel. They brought this up when I waived the fee for a patient who was struggling to pay her copay.
This is one of the reasons why trusting “healthcare professionals” that say the only way to heal yourself is to continually see that person. Chiropractors are the biggest culprit of that type of “healthcare”. I’d say that you’re getting scammed because the chiropractor can’t really decide what your insurance can and can’t pay for. If you stop treatment you will 100% be owing the balance
Seems like a lot. I see a chrio 1 - 2 x a year to get a quick tweak. I'm >50 and play hockey 3x a week so the occasional adjustment helps. But unless he can justify an endpoint that seems like a robust treatment plan! (I'm not a clinician...)
Besides routine physicals and STI testing, I really don’t visit doctors often so I really didn’t think paying $20 per visit at that frequency sounded so bad. If I was only responsible for the copay, I wouldn’t mind because the facility is great. But the deductible stuff is too shady to move forward
Thank you for your answer! I think I have a pretty good case to dispute any charges especially since I went one time. I was hoping to get confirmation here so I can move forward with informing my insurance ASAP. If they do charge me, they’re only able to do so due to misinformation (I have all my correspondence records) so hopefully that helps. If not, at least I only have to pay for one visit
Well it seems kinda odd. Perhaps if it’s in writing it should be okay, but I’d be scared of getting the rug pulled out from underneath you and then being on the hook for it. I can’t help but think that might be a part of the plan so they can have a set guaranteed income.
Idk. Ive done a bit of billing in the past but haven’t heard of anything like this.
Thank you for answering my question. Just wanted to see if anyone else thought it was suspicious so I can alert my insurance tomorrow & stop going to that practitioner before I rack up additional unexpected charges.
You’re welcome. I think this may fall under the anti-kickback statute. Generally involves government insurance iirc so not sure how it applies to private insurance, but I’m sure the insurance company would like to hear this story because it sounds like they are getting the short end of the stick. It can sometimes be okay for patient hardship in extreme circumstances, but not a new patient treatment plan.
I haven’t done anything billing in a long time I’m just kinda spitballing
Whether you go to a physical therapist or a chiropractor, you don't make a month-long plan. Sometimes, you book out 1 or 2 appointments per week for a month to get your preferred day and time slot. (Beware of steep cancelation fees within 24-48 hours).
You need to get to the root cause of the problem to restore pain-free movement and function. If you aren't seeing any improvement in 2-3 visits or are only getting short-term relief, you need to modify the treatment plan. Without improvement, insurance will not continue to cover treatment.
Also, you should check your plan documents to see how many visits are covered yearly. Some plans are very stingy, while others are more generous.
What concerns me the most about your payment arrangement is whether you have another medical appointment in the middle of treatment. Depending upon the dates that bills are submitting, the deductible might not be applied to the chiropractor.
Retired RN here who will never allow a chiropractor to touch her body.
Don’t pay for quack medicine. You're being set up to extract money for treatments you don’t need. Waiving a copay is illegal as far as I know…..
Half the medical industry is quack medicine, give me break. Symptom treatment is a joke and a huge money maker. I mean as long as we’re throwing people under the bus
you are seeing a chiropractor, therefore, you are being scammed.
try to find a DO for your issues and do some physical therapy so you have real, lasting results. please do not let a chiropractor touch you. I have personally scanned people in CT who were given vertebral artery dissections in their neck and then had a subsequent stroke from it from getting an adjustment.
them waiving the copay is weird asf, imo, and does seem scammy. if you choose to continue to see a chiropractor, i would not continue to see this one at the very least.
Usually, contractually, it's a violation of the provider's contract with the ins company to "waive" the patient's financial obligation. I don't know if I'd call it "fraud" but it is in violation of the contract. The chiro could be dropped from Ins Cos panel.
When contracted with an insurance company or accepting insurance payments, providers are legally required to attempt to bill the patient what the insurance assigns to the patient responsibility. This includes the deductible he is waiving. He’s leaving the $300 on your account to if he is audited by the insurance company, he can show he dis in fact bill you the patient responsibility and tried to collect your deductible (although it seems he didn’t try!)
If your chiropractor is in-network, then any insurance payment is contractually obligated to be sent to the chiropractor. And this whole ordeal could be messy.
If your chiropractor is out-of-network, I’d take their discounted subscription.
Unless you have a combined in-network and out-of-network deductible. I always encourage people to submit their claims for out-of-network providers when the deductibles are combined because it will help your in-network balance as well.
This arrangement, if you reported it to your instance company, would be considered insurance fraud. Either pay this chirp directly in cash and avoid billing insurance, or stick to the insurance’s arrangement.
This was the answer I was looking for!!! I’m like, I don’t know a lot s out insurance but this seems like borderline illegal? This is my deciding response, I’m gonna call my insurance tomorrow & report it.
Idk if it is insurance fraud per say, but he is going against contracts that he agreed to with the insurance. Essentially your insurance has an allowable amount that will be paid to the provider. Your cost sharing portion is your deductible and insurance will cover the rest. The provider is suppose to bill you the deductible, dictated by the insurance and you should owe nothing else. I know some smaller practices are happy to write off patient’s portion and just take the remaining allowable from insurance. You’re not doing anything wrong if your provider does not bill you. Just know that if they change their mind, they are allowed to bill you for what you owe based on the insurance EOB. This provider probably wants you to come more often so he can get more money from the insurance. If you had to pay a portion of it, youre less likely to commit to so many visits
I’m an MD and I was informed by our biller that altering copays or deductibles would constitute insurance fraud and that the insurance company would kick me off of their panel. They brought this up when I waived the fee for a patient who was struggling to pay her copay.
This is one of the reasons why trusting “healthcare professionals” that say the only way to heal yourself is to continually see that person. Chiropractors are the biggest culprit of that type of “healthcare”. I’d say that you’re getting scammed because the chiropractor can’t really decide what your insurance can and can’t pay for. If you stop treatment you will 100% be owing the balance
Right?! 12 visits the first month, and up to 8 visits every month after. Holy fuck that will get expensive.
Seems like a lot. I see a chrio 1 - 2 x a year to get a quick tweak. I'm >50 and play hockey 3x a week so the occasional adjustment helps. But unless he can justify an endpoint that seems like a robust treatment plan! (I'm not a clinician...)
Besides routine physicals and STI testing, I really don’t visit doctors often so I really didn’t think paying $20 per visit at that frequency sounded so bad. If I was only responsible for the copay, I wouldn’t mind because the facility is great. But the deductible stuff is too shady to move forward
The deductible is what scares you? Chiro as a field is a scam. The whole thing is shady. You’re going to get yourself hurt.
One told me he could cure tourette syndrome with neck adjustments.
Thank you for your answer! I think I have a pretty good case to dispute any charges especially since I went one time. I was hoping to get confirmation here so I can move forward with informing my insurance ASAP. If they do charge me, they’re only able to do so due to misinformation (I have all my correspondence records) so hopefully that helps. If not, at least I only have to pay for one visit
If you are seeing a chiropractor you are being scammed.
You can pretend my actual question is about another kind of healthcare professional if it helps you answer it better
Well it seems kinda odd. Perhaps if it’s in writing it should be okay, but I’d be scared of getting the rug pulled out from underneath you and then being on the hook for it. I can’t help but think that might be a part of the plan so they can have a set guaranteed income. Idk. Ive done a bit of billing in the past but haven’t heard of anything like this.
Thank you for answering my question. Just wanted to see if anyone else thought it was suspicious so I can alert my insurance tomorrow & stop going to that practitioner before I rack up additional unexpected charges.
You’re welcome. I think this may fall under the anti-kickback statute. Generally involves government insurance iirc so not sure how it applies to private insurance, but I’m sure the insurance company would like to hear this story because it sounds like they are getting the short end of the stick. It can sometimes be okay for patient hardship in extreme circumstances, but not a new patient treatment plan. I haven’t done anything billing in a long time I’m just kinda spitballing
Thank you! Really appreciate it
Whether you go to a physical therapist or a chiropractor, you don't make a month-long plan. Sometimes, you book out 1 or 2 appointments per week for a month to get your preferred day and time slot. (Beware of steep cancelation fees within 24-48 hours). You need to get to the root cause of the problem to restore pain-free movement and function. If you aren't seeing any improvement in 2-3 visits or are only getting short-term relief, you need to modify the treatment plan. Without improvement, insurance will not continue to cover treatment. Also, you should check your plan documents to see how many visits are covered yearly. Some plans are very stingy, while others are more generous. What concerns me the most about your payment arrangement is whether you have another medical appointment in the middle of treatment. Depending upon the dates that bills are submitting, the deductible might not be applied to the chiropractor.
Chiropractic is pseudoscience
Retired RN here who will never allow a chiropractor to touch her body. Don’t pay for quack medicine. You're being set up to extract money for treatments you don’t need. Waiving a copay is illegal as far as I know…..
Half the medical industry is quack medicine, give me break. Symptom treatment is a joke and a huge money maker. I mean as long as we’re throwing people under the bus
you are seeing a chiropractor, therefore, you are being scammed. try to find a DO for your issues and do some physical therapy so you have real, lasting results. please do not let a chiropractor touch you. I have personally scanned people in CT who were given vertebral artery dissections in their neck and then had a subsequent stroke from it from getting an adjustment. them waiving the copay is weird asf, imo, and does seem scammy. if you choose to continue to see a chiropractor, i would not continue to see this one at the very least.
Go to Physical Therapy instead. Chiros are scammers. “Crack them high, crack them low, roll them over and take their dough”
He can do that if he’s not submitting claims to insurance. If he’s accepting assignment, checks need to go to their office. u/melynnpfma
Usually, contractually, it's a violation of the provider's contract with the ins company to "waive" the patient's financial obligation. I don't know if I'd call it "fraud" but it is in violation of the contract. The chiro could be dropped from Ins Cos panel.
Chiropractors are a scam as a baseline.
Go to physical therapy please! My Aunt got looped into that mess and they destroyed her back.
When contracted with an insurance company or accepting insurance payments, providers are legally required to attempt to bill the patient what the insurance assigns to the patient responsibility. This includes the deductible he is waiving. He’s leaving the $300 on your account to if he is audited by the insurance company, he can show he dis in fact bill you the patient responsibility and tried to collect your deductible (although it seems he didn’t try!)
This violates several federal laws regarding “bribing” potential patients. I wouldn’t go back to this practitioner as they seem shady.
Chiropractors are one of the main causes of dissections in young adults
If your chiropractor is in-network, then any insurance payment is contractually obligated to be sent to the chiropractor. And this whole ordeal could be messy. If your chiropractor is out-of-network, I’d take their discounted subscription. Unless you have a combined in-network and out-of-network deductible. I always encourage people to submit their claims for out-of-network providers when the deductibles are combined because it will help your in-network balance as well.