Category Archives: insurance

Auto Insurance Fraud

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As a chiropractor part of my job is taking care of people whom have been in auto accidents. As I have written about before, being in a car accident  is one of the most damaging events you can put your spine through and people whom have been in one legitimately need care.

There is a dark underside to these accidents that a lot of people are not aware of.  Let’s say you are the driver of a car that rear ends the car in front of you.  That person could sue you for injuries sustained in this accident. How bad do they have to be hurt to sue you? Much less than you may think.

Here is where it gets ugly.

The possibility of financial gain has led people to staging accidents. How does this work? You put 6-8 people in a car and pay someone to hit it. The “victims” go to a doctor like myself and run up bills of at least $2,000. That triggers a threshold that allows them to sue the person that hit them. The “victims” ask for a small enough amount that the insurance company settles with them in order to avoid long term litigation.

You may ask, “If it is a small enough amount who really cares?”  Not a bad question if it was occasional, however, when this happens hundreds and thousands of  times a day, the money becomes very real, very quick.

Here in Massachusetts, a 65 year old woman died in a stage auto accident in 2003 in Lawrence which at that time was known as the auto insurance fraud capital of Massachusetts.

The Lawrence police joined forces with a fraud bureau and went to work on steadily reducing auto insurance losses with the thought being they would be able to reduce the amount of insurance premiums that you and I pay.

Were they successful? Were they ever! The crackdown led to charges being filed against 488 people in Lawrence. 488 in Lawrence alone!! That is crazy!

Here is where it gets good. The average auto insurance premium in Lawrence was $1613 in 2003. Today it is $1260! Collectively across the state there has been a $266 million reduction in claims dollars statewide.

Why This is So Important

When there is a lot of fraud, the innocent people get swept up in the mess. The patients that were hurt in legitimate accidents were being treated as if they were guilty of fraud.  The honest doctors and lawyers were getting hammered trying to help people that actually needed it.

As these task forces continue to do their work of reducing fraud, the honest people are going to benefit by getting both the health and legal help that they need.

A Sneaky New Change in Insurance

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November is a big month for renewing insurance plans.  A lot of patients come into the office with insurance questions and over the years I have become fairly adept at reading insurance plans.  It used to be very simple, what was the co-pay, did I have prescription coverage and what sort of flexibility did I have if I am in a jam somewhere far away?

Now the categories have gotten much more complicated.  Take a look at some of the areas of concern:

  • Co-pays…now $25 and up is the norm.  Many plans also charge upwards of $45 for a specialist…
  • Deductibles…do you need to meet a deductible before the plan will cover anything…is it a hospital only deductible?
  • Out of Pocket Maximum…these can range from nothing to $5,000 per individual
  • Prescription coverage…are name brands covered or must you get generic?  Is there a prescription deductible…different co-pays for different levels of drugs.
  • In network vs out of network…go to the hospital and have an x-ray taken…the x-ray is covered but is the radiologist who is reading it?  That makes for a nice surprise when that bill shows up at home.
  • Plan limits… Did you know there may be a lifetime maximum of how much the plan will cover?
  • Service limits…love your chiropractor, how many visits will the plan cover?
  • Lastly co-insurance…this one is nasty with a capital N.

The new thing in insurance plans is co-insurance.  Allow me to explain how that works.  You go to the hospital for a procedure, let’s say a gall bladder removal.  Total cost of said procedure is       $20, 000.  You pay your co-pay and head home.  Two weeks later a bill shows up in the mail for $7000.  7 GRAND!!!!  Welcome to your 35% co-insurance.  Now every plan is not that bad; I have seen this range from 10%-35%, but as you can imagine, this could get expensive.

You must be very diligent when picking your insurance plan.  Please check all of the categories above, especially the co-insurance category before making your decision.

If you have any questions please hit the contact us tab and we will be very happy to help you.  If you are local to me, please bring the plan sheet over to my office and I will gladly walk you through your options.

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Get out the Vote!

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First off, please accept my apologies for the space between posts.  Between the holidays and the start of high school hockey I have slacked here…no more I promise.  For those of you who are interested I coach a high school hockey team and you can follow our progress either through our website (www.ccchsboyshockey.com) or follow us on twitter where we live update the games between periods (www.twitter.com/cchsboyshockey).

While I have always refrained from talking politics in the office, I feel very passionately about the upcoming Massachusetts state election on January 19th, 2010.  The two candidates are:

Martha Coakley www.marthacoakley.com

Scott Brown, www.brownforussenate.com

This election will be crucial in the health care debate.

Ms. Coakley in a word is for the health care plan that is being voted on, while Mr. Brown in a word is against this plan.

While I don’t judge and do not want to turn this into a political debate, I would encourage everyone to take a few minutes out of their day and research both the pros and cons of the current health care plan that is being proposed.

For sure there are no easy answers.  While most people would agree that more people under insurance care is better, others would ask how are we going to pay for this.  These are all issues that you should research before you head to the poll on the 19th.

Given how close the health care vote is sure to be, many national political pundits believe that the winner of the Mass election may be the swing vote in whether or not this plan gets passed, it is imperative that we get out and show not just the state, but the entire country that we care and are passionate about electing our leaders.

Please do your homework and get out and vote on the 19th!

Are Insurance Companies Penny Smart

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I recently had a patient hurt himself.  He called me for an exam and possible treatment, however, was dismayed to hear that his insurance would not cover the visits.  Since he was in a considerable amount of pain, he went to the ER, his primary care physician and a specialist.  Total cost of all those visits:  over $9,000.

One week after seeing all his docs, he was no better.  At this point he came into the office, we agreed on a fee, and got to work on getting him better.  After his first visit he was 75% better, leaving the office stating that he had not been able to breathe this well in a few weeks.  By the third visit the patient was released from care 100% better.

Total cost to the insurance company would have been less than $300.  Most health insurance companies put huge restrictions on chiropractic care.  Yet they will gladly pay and pay and pay when a patient goes into a hopsital or doctors office for diagnostic tests.

Imagine the money saved if 60,000 chiropractors had this type of case 3 times per week.  $4,700 x 3= 14,100 dollars per chiropractor per week.  Now take the roughly 60,000 chiropractic offices in the country and the number jumps to $846 million per year.  Not a bad number.

I often ask patients how many insurance companies they have had over the last 10 years.  It is not unusual for that number to be 5, 6 or even 10.  I then ask them how many spines they have had in that time period.  Of course the answer is 1.

You only have one body, it is not up to the insurance company to take care of it.  If you don’t have insurance or your coverage is very limited, please talk to your chiropractor if fees are a concern.  You may be surprised at what he or she has to offer.