Possible Fraud from Chiropractor

[Roberts2339]

What is the name of your state (only U.S. law)? MO

Back in March I started seeing chiropractor. They were out of network with my insurance. Said they needed to get a pre-authorization before I could start my treatment. Which they got a few days later. About a month ago the claims finally hit my account and bcbs of kc declined them by saying there was no pre-auth. I talked to my doctor who said they'd appeal it. Last week I was talking to bcbs about something else and decided to ask if there was any movement on the appeal. They said they had no record of one. I then asked about the pre-authorization issue. They said my doctor never got one, and if they did I would've received a letter. They also said that if there was some sort of an error my doctor could provide me with a reference number or a copy of the authorization. So I asked my doctor to provide me with that, and they keep on finding excuses on not giving it to me. I've paid close to 3 grand out of pocket and just want my reimbursements. Any thoughts?

 

[quincy]

What is the name of your state (only U.S. law)? MO

Back in March I started seeing chiropractor. They were out of network with my insurance. Said they needed to get a pre-authorization before I could start my treatment. Which they got a few days later. About a month ago the claims finally hit my account and bcbs of kc declined them by saying there was no pre-auth. I talked to my doctor who said they'd appeal it. Last week I was talking to bcbs about something else and decided to ask if there was any movement on the appeal. They said they had no record of one. I then asked about the pre-authorization issue. They said my doctor never got one, and if they did I would've received a letter. They also said that if there was some sort of an error my doctor could provide me with a reference number or a copy of the authorization. So I asked my doctor to provide me with that, and they keep on finding excuses on not giving it to me. I've paid close to 3 grand out of pocket and just want my reimbursements. Any thoughts?

I suggest you go to your chiropractor's office and request in person the reference number or copy of the authorization. Inform the doctor that you will need this if he expects to get paid.

 

[adjusterjack]

Any thoughts?

Lots of them:

1 - Stop seeing him. Go to a real doctor (orthopedic specialist) for an evaluation. Chiropractic is quackery in the first place. Why they are allowed to practice is beyond me.

2 - Don't pay him any more money.

3 - Put your demand for documentation in writing.

4 - File a complaint with the Board of Chiropractic Examiners:

http://pr.mo.gov/chiropractors.asp

5 - Sue him if nothing else works.

 

[Roberts2339]

I suggest you go to your chiropractor's office and request in person the reference number or copy of the authorization. Inform the doctor that you will need this if he expects to get paid.

The Doctor has is getting paid regardless. Every month $290 is taken out of my bank account and I had to pay a $600 down payment.

 

[quincy]

It could be important to note that no one should visit or start treatment with an out-of-network doctor before checking with their insurer that all of the necessary pre-authorization papers have been submitted and received and that treatment has, in fact, been pre-authorized.

Even if a visit/treatment has been pre-authorized, this does not necessarily mean that all costs are covered.

 

[Zigner]

The Doctor has is getting paid regardless. Every month $290 is taken out of my bank account and I had to pay a $600 down payment.

Get a new bank account.

 

[adjusterjack]

The Doctor has is getting paid regardless. Every month $290 is taken out of my bank account and I had to pay a $600 down payment.

That's on you for letting anybody automatically dip into your bank account.

 

[quincy]

The Doctor has is getting paid regardless. Every month $290 is taken out of my bank account and I had to pay a $600 down payment.

You can have the automatic payments stopped until you figure out whether or not you need to pay for the chiropractor's treatment.

You really should have checked with your insurer first, to make sure that the chiropractic treatments were pre-authorized instead of relying on the chiropractor's word that proper papers were submitted and approved.

If you cannot get this resolved on your own, I suggest you review the facts with an attorney in your area.

Good luck.