Your Insurance Questions Answered

INSURANCE COMMITTEE
INCOMING QUESTIONS FROM MEMBERS WITH ANSWERS:

1- QUESTION:
Is it true that the Worker's Compensation (WC) treatment schedule/care plan ALWAYS follows the rule of 3x/wk for 4 wks, 2x/wk for 4 wks, 1x/wk for 4 wks in order to be covered and paid for under WC?, Or, in some cases can there be exceptions made based on the patient's specific needs?

ANSWER:
Standard guidelines for chiropractic care for Worker’s Compensation are as follows:

  • A patient can be treated for up to three times per week, for four weeks, up to two times per week for the next four weeks with a maximum duration of 12 weeks.

  •  Any additional visits needed during this initial 12 week period and or any additional care after the 12 week period would require the submission of a variance using form MG2.

  • All treatment is based upon proper medical necessity, mandatory periodic reevaluation’s and evidence of functional gains.

2- QUESTION:
Can an employer tell an employee to use FMLA (Family Medical Leave Act) instead of taking time off through Workers Compensation?

ANSWER:
An employer can tell an employee to file for FMLA however, this would be in addition to NOT instead of Worker’s Compensation. The employer has the choice to pay the employee their regular salary or not. If the employer chooses to pay the regular employee salary under FMLA this could be deducted from the employees’ vacation and or sick time. A benefit for filing for FMLA would be that an employee’s position would be secure and held for 12 weeks.

3-QUESTION:
If we have a patient who has a Medicare Advantage plan with an insurance company (participating or not) do we need to provide an ABN?

ANSWER:               
 Any patient who elects to go through an alternative insurance carrier other than the traditional “Medicare Part B plan” must follow THAT insurance company’s policy. Medicare does not oversee Medicare Advantage Plans offered by other insurance company’s and is no longer responsible for the individual or the care he/she receives.  As a result, you DO NOT have to provide an ABN.

An ABN still could be used to effectively communicate what is and is not covered by his/her personal Insurance policy. A signed ABN provides a reference that a conversation was had about said services. The ABN is not mandatory by any other insurance company besides Medicare, but it is beneficial to use. 

4-Question:
Can a doctor charge more than the limiting charge to a Medicare patient who is in maintenance care and has signed an ABN?

Answer:
According to the information that has been reviewed, we believe you should be able to charge more then the limiting charge for a service that is not reimbursed by Medicare, providing you have an ABN form that has been satisfactorily signed and accepted by the patient.

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