Guest guest Posted November 10, 1999 Report Share Posted November 10, 1999 Hi All, I have traditional BC/BS and I have no trouble getting treatment, but I live in Michigan and of course there isn't any lyme disease here. I am fearful if they ever declare it an endemic state that the insurance companies will follow " STEERE's advice. It is a catch22. Although I do have aperson in my support group on state medicaid and has been approved for IV " S the second time around. Sheesh! my typing is bad......could it be lyme?? take care all, Connie, MI Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2001 Report Share Posted October 16, 2001 I remember 10 years ago fresh out of WSCC. I had a patient with stomache pain. His history indicated that it was not a dangerous situation requiring an expensive and worthless upper GI so I adjusted him. (I only knew how to adjust dorsals at the time.) He got better! I billed Blue Cross and they denied payment. I called the adjuster and she told me to change it to Thoracic Sprain and she would be happy to pay. I changed it and viola! the claim was paid. One more nail in the database coffin showing that chiropractors only treat sprains and strains. DD and BJ must have been turning over in their subterranean adjustatoriums. (The solution was so simple. Now if we could just convince the Isralis that if they would just close their country and cease to exist, there would be peace in the middle east.) -- Dr. Abrahamson Caution: parts of the above message are indended for HUMOR and in no way reflect the views of the author, the listserve or anyone with any sense. Any relation to any person in the message living or dead or a combination of the two i.e. heavily involved with managed care, is purely coincidental. > From: " lumsden " <lumsden@...> > Date: Wed, 17 Oct 2001 02:48:18 -0700 > < > > Subject: Blue Cross > > More joy from the front lines today. Had a claim rejected because I diagnosed > anxiety disorder in a patient who plainly had it, then diagnosed cervical and > thoracic hypertonus as secondarys. They refused payment because " anxiety > disorder " is not a chiropractic diagnosis. My assistant was coached to > re-bill and leave off the Anxiety stuff and they would likely pay. Geeze, I > think the sides of this box are coming in! Steve Lumsden > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2001 Report Share Posted October 16, 2001 I think I now have anxiety disorder. scott s. Blue Cross More joy from the front lines today. Had a claim rejected because I diagnosed anxiety disorder in a patient who plainly had it, then diagnosed cervical and thoracic hypertonus as secondarys. They refused payment because "anxiety disorder" is not a chiropractic diagnosis. My assistant was coached to re-bill and leave off the Anxiety stuff and they would likely pay. Geeze, I think the sides of this box are coming in! Steve Lumsden Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2001 Report Share Posted October 17, 2001 Steve; Did anyone advise you just what a " chiropractic diagnosis " is in the first place, and what guidelines they used to make the determination? Les At 02:48 AM 10/17/01 -0700, lumsden wrote: More joy from the front lines today. Had a claim rejected because I diagnosed anxiety disorder in a patient who plainly had it, then diagnosed cervical and thoracic hypertonus as secondarys. They refused payment because " anxiety disorder " is not a chiropractic diagnosis. My assistant was coached to re-bill and leave off the Anxiety stuff and they would likely pay. Geeze, I think the sides of this box are coming in! Steve Lumsden Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2001 Report Share Posted October 17, 2001 Dear Steve, Perhaps we aren't looking at this correctly. Perhaps the insurance company is giving the DC credit and acknowledgement for what we have preached and known anecdotally all along, and that is that the primary and only diagnosis for a Chiropractor relates only to the concept that the cause and cure of all dis-ease or disease lies within the spine. So, maybe we should erase any ideas of other primary diagnoses and stick to the mantra that we have chanted for so very long that 'when the spine's in line, everything's fine'. Finally, someone heard us ! Sharron Fuchs dc (certainly not as witty as dr. abrahamson could write, but a touch of cynicism none the less.) Re: Blue Cross I think I now have anxiety disorder. scott s. Blue Cross More joy from the front lines today. Had a claim rejected because I diagnosed anxiety disorder in a patient who plainly had it, then diagnosed cervical and thoracic hypertonus as secondarys. They refused payment because "anxiety disorder" is not a chiropractic diagnosis. My assistant was coached to re-bill and leave off the Anxiety stuff and they would likely pay. Geeze, I think the sides of this box are coming in! Steve Lumsden Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2001 Report Share Posted October 17, 2001 Yea right,... " and the world would live as one. " Steve Blue Cross > > > > More joy from the front lines today. Had a claim rejected because I diagnosed > > anxiety disorder in a patient who plainly had it, then diagnosed cervical and > > thoracic hypertonus as secondarys. They refused payment because " anxiety > > disorder " is not a chiropractic diagnosis. My assistant was coached to > > re-bill and leave off the Anxiety stuff and they would likely pay. Geeze, I > > think the sides of this box are coming in! Steve Lumsden > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2001 Report Share Posted October 18, 2001 Excellent point Les, but a circular path of inquiry I am sure. It really should be pressed though. The trouble is you really have to sue them at some point, but possibly the Insurance Commissioner could be of help...Steve Re: Blue Cross Steve;Did anyone advise you just what a "chiropractic diagnosis" is in the first place, and what guidelines they used to make the determination?LesAt 02:48 AM 10/17/01 -0700, lumsden wrote: More joy from the front lines today. Had a claim rejected because I diagnosed anxiety disorder in a patient who plainly had it, then diagnosed cervical and thoracic hypertonus as secondarys. They refused payment because "anxiety disorder" is not a chiropractic diagnosis. My assistant was coached to re-bill and leave off the Anxiety stuff and they would likely pay. Geeze, I think the sides of this box are coming in! Steve Lumsden Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2001 Report Share Posted October 18, 2001 Steve; What, you mean we aren't dealing with men and women of good will at the insurance companies? You are probably right that at some point a suit would be necessary to resolve the question. I think the same may be true of the spreading problem of insurers misappropriating the medicare guideline regarding bundling every chiropractic service in the universe as inclusive to 9894X series codes. Soon they'll be telling us we can't charge for x-ray exams as they are " preparatory to the 9894X service " . I'd like to see the insurance industry bundling issue addressed in a suit. Les At 07:09 AM 10/18/01 -0700, lumsden wrote: Excellent point Les, but a circular path of inquiry I am sure. It really should be pressed though. The trouble is you really have to sue them at some point, but possibly the Insurance Commissioner could be of help...Steve Re: Blue Cross Steve; Did anyone advise you just what a " chiropractic diagnosis " is in the first place, and what guidelines they used to make the determination? Les At 02:48 AM 10/17/01 -0700, lumsden wrote: More joy from the front lines today. Had a claim rejected because I diagnosed anxiety disorder in a patient who plainly had it, then diagnosed cervical and thoracic hypertonus as secondarys. They refused payment because " anxiety disorder " is not a chiropractic diagnosis. My assistant was coached to re-bill and leave off the Anxiety stuff and they would likely pay. Geeze, I think the sides of this box are coming in! Steve Lumsden Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2008 Report Share Posted April 11, 2008 Annette, Did you do this on your own or did you need to hire an attorney? The next logical step for me is to file with the State Insurance Commissioner's Office but I'm concerned about doing this on my own. Your experience with this would be greatly appreciated!! Annette <radznsc@...> wrote: Blue Cross was horrible to me. I fought for close to a year to get my Xolair approved. After denial, appeal, denial, I finally had to file a claim against them with the government medical review board. They found in my favor and forced BC to pay. Health Net on the other hand has been a good company to work with, even if the premiums are incredibly high. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
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