We are most concerned about our Veterans and are willing to do almost anything to help them.
These cases are handled similarly.  Both traditionally have not been  easy to manage and therefore to accept under assignment.  We have dealt with both carriers. In each case  it was difficult to receive fair compenation, which in turn affected the doctor/patient relationship. 

We do not want bills to accrue without compensation because the patient could be left with a bill.  It is never to be assumed that the costs for treatment if unpaid by any carrier are not owed to the provider.  The patient always has this risk, but anyone who is trying to help with your services should not be taking these risks, because you are not their only patient.  If the carrier fails to pay, the patient must become an advocate for their own  interests and seek out a resolution of the fees before treatment can be continued.  We can help, but it is entirely up to you.

We want these programs to work for you, so we ask that you demand from these carriers that they allow you to use our chiropractic and therapeutic procedures to help you.  We would have to operate within all standards for medical care by initial examination and testing to providing a plan of care.  (See Plan of Care under Medicare).  We are primary care physicians, and it is not up to an allopathic doctor, MD or DO. to make this determination. You still have some freedom to select your care, and we are a separate and distinct health care service validated by all 50 states.

Once a plan of care is approved. You cannot pick or choose from the prescribed procedures or they would likely not reimburse the provider because they did not follow the pre-approved standard of care.  You would have to be dismissed for noncompliance.  Therefore, these procedures would have to be preapproved with careful consideration given to any limitations or exclusions.  They are less likely to want to approve a more wholistic approach to your concerns.  From their point of view, they see each patient as if they have only one regionally specific health problem almost as though you were a automobile where "parts are parts" and tend to exclude anything else.  "No one is being rewarded for problem solving and being creative."  They see us as a therapist who bills like therapists by bundling and putting forth the most that can reasonably be done to help you  in one visit or more like someone who is only managing your complaints.   They want to believe that you are going to get better in a short concentrated set of treatments.  To them, the chiropractic adjustment is no more than just another 15 minute therapy.  After 12 visits in a plan of care, they will require a reevaluation with exam and then very elaborate well documented data justifying an extension for another prescribed plan.  All must follow these protocols to expect compensation.  If they place too many limitations on your care to the point that it is unethical and not reasonable for us to  expect success, we must decline the case.

All billing is mailed to the carrier, so it takes time as bills accrue before they are paying out on the claims.  Even with a careful preapproval of codes to be used and the corresponding plan of care, their third party claims departments are hired to save money and delay payments. Chiropractors unlike medical physicians have smaller practices and often do their own billing.  They are not part of a larger practice where how a claim settles becomes part of their responsibility or understanding.  In a small office, a large unpaid workmen's compensation  bill for one patient may represent the equivalent of lost income for a whole week when there are only at best 20 work days a month. 

As a result, we have to monitor very carefully how quickly the bills are paid.  Also it  must be understood that we cannot be unfairly burdened with documentation and additional paperwork for delivery of services that were preapproved for a specified number of visits.  Often we have felt that these parties do this to delay paying claims and discourage continuation of care.

We are most concerned about handling Veteran cases and are willing to do almost anything to help Veterans.  We provide an excellent service and wish to help many veterans; it is  unfortunate that they make it so difficult for chiropractors to participate.   The nurse case manager makes the approval.  A case does not have to go through a medical doctor.  We are primary care physicians and it is not spelled out anywhere that a medical doctor must approve the case.  Payment for services does not require any identification of their number.  With unsettled Veteran cases there is little to no recourse, unless you personally go to advocates and internal case representatives who are supposed to represent your interests.  There is, however, no unbiased party on your behalf.

Most of this is also true of workmen's compensation.  Preapproval is necessary, but even more so,  it is a problem with how fast claims are settled.  Some only get settled by a judge in a hearing that eventually comes about a year later after the patient and his/her doctor have part ways sometime ago.  Regular timely approval payments comes only from the third party carrier who pre-approved the case with the company from where you had your accident.   These carriers come and go based on how much money they can save that company.  One who pre-approved the case could be out of picture later on, and the new carrier is very motivated to cut costs, delay claims, and deny claims that were previously approved and being paid for.  Care gets interrupted and treatment becomes inconsistent.  Often the better doctors and practices get so discouraged that only less established professionals venture into this territory.  To date we have had only cases where it became very intense, took much time and management, and only paid out a small fraction of the accrued services used.  

We are still willing to try again on behalf of those people whose family and friends encouraged Workmen's Compensation patients to contact us.
  It helps to have a good attorney and a strong bargaining unit, but whenever you are no longer as active a part of the bargaining unit as when you were working , in active service and paying the dues, sometimes they are not so inclined to help you.  It is also important that you are willing to become an advocate and willing to file a complaint with the insurance commission of the State of Alabama as soon as possible when claims are delayed and then tell the carrier and the company that you have done so.  Remember in workmen's compensation, you are essentially excluded from any other way of receiving care for your injuries and the State of Alabama can protect your interests with workmen's compensation, auto insurance, and all health insurance companies, except Blue Cross Blue Shield.

It may be well that our experiences with Veterans and Workmen's Comp is a continued problem that only chiropractors face in the inequity of payment and inclusion that these health care systems provide, or the large scale monopoly that the medical industry, MEDICINE INC., has over established business and the government.  Workmen's Compensation is required of all employers for the protection of their employees, but since all  have it, it's a great big industry in itself;  third  party carriers become opportunists who move into the void for profit that only can be generated by skimming from he victim and provider who their representatives are trained to see as cheaters; chiropractors may seem to them to be an easy target.  Even Medicare is not serviced by Medicare; it is serviced by a third party company, Cahaba.    In any monopoly, the quality of care generally goes down and the disabled worker and military service person become further victims. 

"You deserve the best care and/or the freedom to select your care from a free market; also all businesses require equity in this market so they can compete, and,  in turn, be able to  provide quality care for a prompt and fair compensation."

"Anything short of this is purposely designed to negatively influence choice and is constructed to control and jeopardize the sanctity of the doctor/patient relationship, or, put another way, jeopardize control over our own body, something we were thought to have as Americans."

                                           Dr. Katherine Crafton

"You deserve the best care and/or the freedom to select your care from a free market; also all businesses require equity in this market so they can compete, and, in turn, be able to provide quality care for a prompt and fair compensation."

           Dr. Katherine Crafton
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