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SettlementCentral.com The Online Resource for Personal Injury
Claims
Volume 3 Issue 4
In this issue April 2005
Denial of Chiropractic Payments by the Adjuster
•
Denial of benefits by discounting chiropractor billings that
“exceed reasonable and customary” charges
• Why your insurance SHOULD pay
• How to get your
insurance to pay these charges
Settle-It-Yourself Newsletter
Hello!! Welcome
to the April edition of Settlement Central’s Newsletter. We are
pleased to share this newsletter with you, as our business is
helping people get satisfactory settlements for their personal
injury claims.
We will be
continuing our discussion regarding denial of chiropractic
payments by the adjuster. In this issue we will discuss what to
do when your own insurance Personal Injury Protection (PIP)
adjuster denies full chiropractic benefits by discounting
chiropractor billings that “exceed reasonable and customary”
charges.
As always, we
will post our articles on our website as they are sent out in
the Settle-It-Yourself Newsletter. Our readers will have a rich
resource available to them, our hands-on battles with the
insurance companies translate into useful and accurate
information for our readers.
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Denial of Benefits by Discounting Chiropractor Billings That
“Exceed Reasonable and Customary” Charges
All too often we
see examples where the PIP adjuster refuses to pay the
chiropractor's FULL charges, and insists on "discounting" his
invoices. The adjuster will justify her actions by stating that
the doctor's charges exceed the norm expected in the area
(except she will call the norm the "reasonable and customary"
charges), and thus they must be discounted to meet the norm
since the PIP obligation is to pay only "reasonable and
necessary" medical charges, and by definition those charges in
excess of the norm are not reasonable.
If you encounter
this type of insurance tactic, you must remember- Chiropractic
charges are both necessary and reasonable: the doctor gave
needed chiropractic professional treatment and worked hard to
treat your injury, and billed appropriately for his charges. And
there is no reason to compromise his professional standards or
practice by stooping to accept this kind of attack.
When you
encounter this type of insurance tactic, the first thing you
should do is to ask your insurance adjuster to submit that
explanation to you in writing. That will give you something to
work with in rebutting her assertions-and if complaining to your
state Insurance Commissioner, if necessary.
The next thing to do is to make a good record of the
conversation, with all basics of time, etc., plus as much of her
diatribe as you can remember.
The third thing to do is to discuss this topic with your doctor.
He will not be offended to hear that someone has challenged his
billings because if he is like many other good injury doctors,
he has heard much of it before. You can assure him of your
continued faith in his professional care, and at the same time
ask him what he recommend be done.
So what kind of
response should you give your insurance adjuster to convince her
to pay these charges? We have formatted an example letter for
just this type of situation.
Please Click here
http://www.settlementcentral.com/format.php?Page=8019, for
our free Patient's Letter to the Adjuster Re: Denial of Benefits
by Discounting Chiropractor Billings That “Exceed Reasonable and
Customary” Charges
Thank you for your
interest in our site; we hope you will find us to be an
excellent source for your own personal injury needs!!
Jeanine Steele
Publisher, Settle-It-Yourself Newsletter
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About SettlementCentral.com
http://www.settlementcentral.com
SettlementCentral.Com, Inc. is a Washington corporation
providing general educational information, online, to personal
injury victims throughout the United States on how to manage
their own personal injury claims through the settlement
process—from gathering the necessary information (evidence) to
submitting claims and demand letters, through engaging in
successful personal injury settlement negotiations with
insurance companies. Our online instructions and self-help forms
and letters are designed to make for easy insurance claims
settlements in the areas of auto accidents, pedestrian
accidents, dog bites, vicious animal bites, premises liability,
and slip and fall accidents.
Contact Information
Your comments and suggestions are welcome! Tell us what topics
you would like to see discussed in this newsletter and we will
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