Greetings to Doctors of Chiropractic! This page is provided as a courtesy to you in order to assist your patients who might have run up against a PIP insurance adjuster who does not understand the benefits of chiropractic care. You are free to use anything on this page and the three letters that are linked from here, whether or not you ever apply to become a member of the SettlementCentral.Com Chiropractor Network.
 
Chiropractors may become aware of the relationship between their patient and an insurance adjuster in any number of ways, but one common problem arises in first party claims. All too often we see examples where the PIP adjuster refuses to pay the chiropractor's FULL charges, and insists on "discounting" his invoices.
 
What should the doctor do or say when you become aware of this insurance tactic?
 
Failure to pay your FULL charges by "discounting" chiropractic care 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.
 
First, we hope doctors do not accede to this abusive tactic by knocking off or forgiving the unpaid portions of some of their billings. That would do no one any good. Chiropractic charges are both necessary and reasonable: the doctor gave needed chiropractic professional treatment and worked hard 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.
 
Second, we recommend that the doctor let the patient know that the charges will remain owing, even if his PIP insurance is only willing to pay a portion of them. It is HIS INSURANCE PROBLEM to fix, not the doctor's. If he starts compromising on balances the patient owes, the doctor will remove any incentive THE PATIENT HAS to go out and fight the battle to fix this problem. Sure, the doctor stands ready to offer help in the form of a letter justifying the charges, if necessary.
 
But he also needs to remind the patient of HIS obligation: he promised to pay for chiropractic services, and if his insurance source of payments dries up, that does not relieve him of the duty to pay those reasonable chiropractic fees.
 
Of course it is tempting to give in and write off fees that are challenged, in part because after all the adjuster is alleging that the doctor did something wrong by billing too much. But when the chiropractor and his patient both understand that this is an abuse the PIP adjuster has pulled often in her work files, then both should be filled with resolve to fight back and keep her from trying this with any other doctors.
 
Third, we respectfully suggest six coordinated actions:

1. Counsel the patient along the lines set forth above; this chiropractic practice and its billings are proper-it is THE PATIENT'S insurance adjuster who is trying to abuse the patient.
   
   
2. Give the patient the URL links to letters below to write to his insurance company, and also the one to write to the insurance commissioner. Make sure that he knows he is NOT supposed to let his tone become threatening or angry: just be firm, but business-like in his response.
   
   
3. Offer to write a chart note letter providing additional information, along the lines as set forth below.
   
   
4. If his PIP company will not budge, the patient may have to sign a lien with the doctor for the unpaid balance in the event he has much more care to undertake before reaching maximum medical improvement.
   
   
5. Make a file of insurance abusive tactics and see if this adjuster (or her company) comes up again; discuss some of these tactics with other chiropractors to see how they are handling them.
   
   
6. Let us know about any unusual or new tactics by the insurance adjuster: maybe we have heard about how other chiropractors dealt with them; we will make the information part of this resource to aid chiropractors and their injured patients. Email us
   
   
7. Explore the benefits to your professional practice and to your patients should you qualify for membership in the SettlementCentral.Com Chiropractor Network. We respectfully encourage you to ACT NOW inasmuch as chiropractors are limited by geographic/population boundaries, and once an area is taken, it is too late to apply.
   

Links to Example Letters

Here are the URL links to the doctor's chart note letter for the adjuster and the two letters you can share with your patient. We hope you do not think we are suggesting that these letters apply to your practice; these are just examples, and any number of different facts could be placed in them; the principle and format are still relevant to different circumstances. You could modify them for the patient if you wanted, or you could just let your patient download them and modify them according to the individual circumstances of his claim and treatment.

• Doctor's Chart Note Letter to Adjuster Regarding "Discounting" Chiropractic Billings.
  
• Patient's Letter to Adjuster Rejecting "Discounting" of Chiropractic Charges.
  
• Patient's Letter to Insurance Commissioner Complaining About "Discounting" of Chiropractic Billings.
  

There is one last IMPORTANT thing you may wish to do: explore the benefits of becoming a member of the SettlementCentral.Com Chiropractor Network. There is absolutely no advertising or listing fee for three years (other than a one-time administrative cost of $47 used to build the Network); you can quit anytime; and we hold you harmless should anyone ever question the information on our site.
 
There are stringent qualifications having to do with your experience in personal injury claims, but if you do qualify, there will be rewards for both your practice and for your patients.

• You will have a free Internet presence where you will be shown in your area as a highly competent chiropractor who can deal with personal injury claims.
  
• Your patients will benefit with the opportunity for a DISCOUNTED membership ($15 off with your initials and zip code) teaching them to settle their claims on their own, without incurring the delays and fees involved with attorney representation.
  
• Your accounts receivable will look better because long overdue billings will be cleared sooner, and without the reductions in fees so often demanded by attorneys.
  

Just go to the SettlementCentral.Com Chiropractor Network Introduction page and learn more about this benefit. We respectfully encourage you to ACT NOW inasmuch as chiropractors are limited by geographic/population boundaries, and once an area is taken, it is too late to apply.
 
Visit Other Chiropractor Resource Pages
 
This is one of three similar SettlementCentral.Com Chiropractor Network Resources Pages that we created to help doctors of chiropractic and their patients deal with PIP adjuster abuses. Here are the links to the other two Chiropractor Resources Pages:

• PIP Adjuster Denial of Benefits by Asserting Chiropractic Care is Only Palliative, not Curative, and Hence is Neither Reasonable nor Necessary
  
• PIP Adjuster Denial of Benefits by Asserting that Chiropractic Care is Based Solely Upon Subjective Complaints, not Objective Symptoms, and Hence is Neither Reasonable nor Necessary