RE: 16 year old denied benefits..

[Guest guest]

Dean,

I had a denial like this 10-12 yrs ago. Can't remember the ins co. But they sited no evidence for pediatric adjusting. I'm working on getting a peds DC to present a seminar at WSCC. She's done lots of research in the field and is currently licensed in Sweden and lecturing in Europe on the subject. She's a WSCC grad.

At any rate, I suggest you prepare a simple narrative outlining the case, History, Exam, Diagnosis, Treatment and Outcome. Send that to the insurance company with a professional cover paragraph explaining viscero-somatic principles. Education is the best way to break this type of denial. You might offer the patient a copy to send to their legislators in order to inform them of the problem. Keep in mind, you're going to hear that there's not enough research on pediatric Chiropractic treatments and outcomes. You might google the subject, it's scant. I'm not defending the lack of coverage, just offering a way to change the insurance denials and explaining the insurance rationale.

My patient was similar. A young 12 yr old with severe digestive problems had gone thru over 1 yr of diagnostic work-up and treatments with no relief. She had to endure upper and lower GI studies and all sorts of medications. My history uncovered a fall off a swing as the onset of thoracic and upper lumbar pain just prior to all the GI symptoms. 6-8 treatments later, her symptoms were resolved.

Minga Guerrero DC

In a message dated 12/4/2008 1:03:41 P.M. Pacific Standard Time, drdeanclark@... writes:

Here's a new one. 16 year old male with severe digestive problems (blocked colon)

Went through several medical procedures with no significant change was brought in by

his mother for a whole new approach. (he is much better by the way)

Just recieved notification from his Cascade Corporation Employee Benenfits EOB

he is excluded from treatment under the age of 18.

Wow, what will they come up with next, Only hair parted on the left side of the head is accepted?

Dean , D.C.

Portland, Oregon

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[Guest guest]

Elise Hewitt here in town is the president

of the ACA Ped Council, and should be able to offer appropriates speakers

Ted Forcum, DC, DACBSP

'08 US Olympic Team Chiropractor

ACA Sports Council, President

Back

In Motion Sports

Injuries Clinic, LLC

11385

SW Scholls Ferry Road

Beaverton, Oregon 97008

503.524.9040

www.bimsportsinjuries.com

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From:

[mailto: ] On Behalf Of AboWoman@...

Sent: Friday, December 05, 2008

8:33 AM

drdeanclark@...;

Subject: Re: 16

year old denied benefits..

Dean,

I had a denial like this 10-12 yrs ago.

Can't remember the ins co. But they sited no evidence for pediatric adjusting.

I'm working on getting a peds DC to present a seminar at WSCC. She's done lots

of research in the field and is currently licensed in Sweden and lecturing in Europe

on the subject. She's a WSCC grad.

At any rate, I suggest you prepare

a simple narrative outlining the case, History, Exam, Diagnosis, Treatment and

Outcome. Send that to the insurance company with a professional cover paragraph

explaining viscero-somatic principles. Education is the best way to break this

type of denial. You might offer the patient a copy to send to their legislators

in order to inform them of the problem. Keep in mind, you're going to hear that

there's not enough research on pediatric Chiropractic treatments and outcomes.

You might google the subject, it's scant. I'm not defending the lack of

coverage, just offering a way to change the insurance denials and explaining the

insurance rationale.

My patient was similar. A young 12 yr old

with severe digestive problems had gone thru over 1 yr of diagnostic work-up

and treatments with no relief. She had to endure upper and lower GI studies and

all sorts of medications. My history uncovered a fall off a swing as the onset

of thoracic and upper lumbar pain just prior to all the GI symptoms. 6-8

treatments later, her symptoms were resolved.

Minga Guerrero DC

In a message dated 12/4/2008 1:03:41 P.M.

Pacific Standard Time, drdeanclarkcomcast (DOT) net writes:

Here's a new one. 16 year old male with

severe digestive problems (blocked colon)

Went through several medical procedures

with no significant change was brought in by

his mother for a whole new

approach. (he is much better by the way)

Just recieved notification from his

Cascade Corporation Employee Benenfits EOB

he is excluded from treatment under the

age of 18.

Wow, what will they come up with next,

Only hair parted on the left side of the head is accepted?

Dean , D.C.

Portland, Oregon

No virus found in this outgoing message.

Checked by AVG.

Version: 7.5.552 / Virus Database: 270.9.13/1828 - Release Date: 12/4/2008 8:05

AM

Make your life easier with all your

friends, email, and favorite sites in one place. Try

it now.