Home > Uncategorized > Chiropractic Bills of Note

Chiropractic Bills of Note

This week marked the introduction deadline for all the bills for the 2013 Legislative Session.  This year there were 5,822 bills introduced; four of which were ICS initiatives.

50% Co-Payment Cap
Senate Bill 1754 attempts to tackle co-payments that take up a majority or entirety of our doctor’s allowed billable amounts.  Senator Sam McCann first started helping us with this issue last year and we hope to see floor action on this measure this legislative session.

The situation we want to address is as follows.  A doc charges $60 for a chiropractic adjustment.  Let’s say the reduced billable amount is $40. The insurance company also has a $40 copay.  In this instance, the insurance company is stating that it has “chiropractic coverage” yet due to the billable amount and the copay, the insurance company never actually pays anything.  Our end goal is to have a 50% copay cap (based on the billable) so that in this instance the insurance copay cannot be more than $20.

Medically Prescribed Diets and DC’s
Senate Bill 1229 corrects an issue where Chiropractic Physicians are prohibited from initiating or consulting with Dietitians or Nutritionists with regards to medically prescribed diets.  We have been systematically removing opposition from this bill and hope to have agreed language in the coming weeks. Senator Iris Martinez (sponsor of our previous OTC and Oxygen bill) has agreed to carry this issue for us.

Binding Verification of Benefits
House Bill 2251 by Representative Tim Schmitz looks for a way to make the verification of benefits that a doctor makes on behalf of his patients binding. All too often, the doctor’s office will call to verify coverage and is told one thing, but then the coverage is denied once the service is performed.  HB2251 does not intend to impact medical necessity, but instead details of essential coverage and what caveats may apply.  The ICS has suggested online verification as a way of producing a paper trail and assuring accuracy
EOB/RA Transparency
Senate Bill 1642, sponsored by Senator Mattie Hunter hopes clean up some of the confusion on EoB’s and RA’s by:

  1. Ensure multiple reductions are broken out individually so you can easily see what was due to copay, coinsurance, deductibles, administrative fees, and reductions.
  2. Clearly stated reasons for denials.
  3. The items and amounts shown to the patient (EoB), must match those sent to the doctor (remittance advice).
  4. An insurer must not issue an EoB claiming a payment has been made unless it truly has been made.

Much of this was brought to our attention when the ICS conducted their study for the CoPay legislation.  It was often impossible to determine how much of a bill was discounted for copays versus any other type of discount.

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Categories: Uncategorized
  1. March 1, 2013 at 10:23 am

    Thanks for your work Rob and the ICS team!

  2. March 2, 2013 at 8:45 am

    Rob, I have seen some PT bills and they were charging several hundred to $500 plus per visit.
    Do the PT’s have any interest in this bill?

    • March 7, 2013 at 11:31 pm

      Sorry Dr. Santolin, I didn’t see your message until now. I have reached out to the various PT groups, but we haven’t had much of a response with regards to our CoPay bill. Our bill wouldn’t actually have much impact on larger billings anyway. If there’s a $40 copay, and office charges of $400, then the $40 copay would be unchanged.

      • Steve Santolin
        March 9, 2013 at 8:00 am

        Rob, That is what I would have thought.

        Thanks

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