SettlementCentral.Com Newsletter

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Issue 21

In this issue

Denial of Chiropractic Payments by the Adjuster

• Denial of benefits by discounting chiropractor billings that “exceed reasonable and customary” charges
• Why your insurance SHOULD pay
• How to get your insurance to pay these charges

Settle-It-Yourself Newsletter

Hello!! Welcome to the April edition of Settlement Central’s Newsletter. We are pleased to share this newsletter with you, as our business is helping people get satisfactory settlements for their personal injury claims.

We will be continuing our discussion regarding denial of chiropractic payments by the adjuster. In this issue we will discuss what to do when your own insurance Personal Injury Protection (PIP) adjuster denies full chiropractic benefits by discounting chiropractor billings that “exceed reasonable and customary” charges.

As always, we will post our articles on our website as they are sent out in the Settle-It-Yourself Newsletter. Our readers will have a rich resource available to them, our hands-on battles with the insurance companies translate into useful and accurate information for our readers.


Denial of Benefits by Discounting Chiropractor Billings That “Exceed Reasonable and Customary” Charges

All too often we see examples where the PIP adjuster refuses to pay the chiropractor's FULL charges, and insists on "discounting" his invoices. The adjuster will justify her actions by stating that the doctor's charges exceed the norm expected in the area (except she will call the norm the "reasonable and customary" charges), and thus they must be discounted to meet the norm since the PIP obligation is to pay only "reasonable and necessary" medical charges, and by definition those charges in excess of the norm are not reasonable.

If you encounter this type of insurance tactic, you must remember- Chiropractic charges are both necessary and reasonable: the doctor gave needed chiropractic professional treatment and worked hard to treat your injury, and billed appropriately for his charges. And there is no reason to compromise his professional standards or practice by stooping to accept this kind of attack.

When you encounter this type of insurance tactic, the first thing you should do is to ask your insurance adjuster to submit that explanation to you in writing. That will give you something to work with in rebutting her assertions-and if complaining to your state Insurance Commissioner, if necessary.

The next thing to do is to make a good record of the conversation, with all basics of time, etc., plus as much of her diatribe as you can remember.

The third thing to do is to discuss this topic with your doctor. He will not be offended to hear that someone has challenged his billings because if he is like many other good injury doctors, he has heard much of it before. You can assure him of your continued faith in his professional care, and at the same time ask him what he recommend be done.

So what kind of response should you give your insurance adjuster to convince her to pay these charges? We have formatted an example letter for just this type of situation.

Please Click here, for our free Patient's Letter to the Adjuster Re: Denial of Benefits by Discounting Chiropractor Billings That “Exceed Reasonable and Customary” Charges

Thank you for your interest in our site; we hope you will find us to be an excellent source for your own personal injury needs!!

Jeanine Steele
Publisher, Settle-It-Yourself Newsletter

SettlementCentral.Com has a wealth of information and special tips for members who wish to arm themselves with the best advice for dealing with insurance companies. Our Negotiation section is filled with fresh and effective ideas on how to approach a company to ensure a successful settlement of your case.
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SettlementCentral.Com, Inc. is a Washington corporation providing general educational information, online, to personal injury victims throughout the United States on how to manage their own personal injury claims through the settlement process—from gathering the necessary information (evidence) to submitting claims and demand letters, through engaging in successful personal injury settlement negotiations with insurance companies. Our online instructions and self-help forms and letters are designed to make for easy insurance claims settlements in the areas of auto accidents, pedestrian accidents, dog bites, vicious animal bites, premises liability, and slip and fall accidents.

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