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TDI Complaints Recoup Income Lost by Doctors
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The Insurance Committee of the TCA reports that following our quarterly conference call with Texas Department of Insurance (TDI) there were several items of extreme interest to the healing arts profession.  The Insurance Committee wants to remind you that you may complain about insurance practices, and that the Texas Department of Insurance has a simple web complaint form for all forms of complaints.  JUST CLICK HERE.

It was reported by the TDI that "year to date, TDI has received only 20 or so complaints against insurance companies from doctors of chiropractic. Last year’s total was more than 100."

It was further reported that "complaints year to date with workers compensation have been 59 and resulted in an additional $15,000 paid out to D.C.’s after the complaints."

The committee also notes that if there are problems with PIP insurance that complaints need to be filed with the TDI at the above link.  If you have a PIP carrier that paid the patient rather than the doctor even though an assignment of proceeds had been filed with the carrier, the TDI solicits your complaints.

The Insurance Committee notes that "If you have a complaint, they need to be filed to get them on record.  This is something that the TDI is requesting from us, and not something we are making up. It only takes a minute to file your complaint.  You need to file them by the dozens if you have that many complaints."

JUST CLICK HERE to initiate the complaint process against an insurance company.  They certainly don't hesitate to complain to your regulatory agency.
 
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Added: September 07, 2010. 12:12 PM CDT
Not Complete Waste of Time
Although TDI turns their noses at ERISA complaints, complaints on file with TDI remain a very important tool for TDI to help us as a profession. The more the better. Further, the PIP complaints are VERY important right now. If a PIP carrier pays your patient and ignores your assignment of proceeds, immediately file a complaint. Please have on record proof that the adjuster had your AOP (do it with certified mail). The issue with PIP, as far as TDI interprets the statute is that there is no statutory language for a PIP carrier to honor the AOB, although there is statutory language for health insurance. That being said, TDI does not believe that there is an insurance policy issued today by PIP carriers that doesn't contain language that the benefits are assignable. So, even though there is no statutory language, their policies state that it is assignable. TDI needs complaints to research this further. The goal would be for less intrusion and hardship between the doctor/patient relationship...which is all that the carrier hopes to accomplish by paying a patient directly.
Todd Whitehead, D.C.
Added: September 07, 2010. 11:04 AM CDT
Filing a complaint a waste of time?
My experience with TDI against such companies as United Healthcare, is that they come back and say sorry, it is an ERISA policy. Most policies are ERISA policies simply of the circumvention of the law. ERISA stood for Employee Retirement Income Security Act. Insurance companies have interpreted it to mean anything that benefits the carrier.
Dr. Laurence Smith
 
 
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U.S. government overpaid private insurance companies administering Medicare Advantage plans by as much as $3.1 billion in 2010, according to a new report from the Government Accountability Office (GAO).

About a quarter of all Medicare beneficiaries are enrolled in Medicare Advantage plans, and the Centers for Medicare and Medicaid Services (CMS) paid about $114 billion to the plans in 2010.


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TCA District 5 asks the question: "Have you ever wanted to get more involved and give back to your colleagues and the Chiropractic Profession? Now is your chance! We are looking for hardworking and passionate DCs to join the TCA District 5 Leadership!"

"This is your chance to be a part of the BIGGEST development of Chiropractic in Texas! Help us make history and preserve our practices for future generations. 2012 is about improving and redefining how Texans understand Chiropractic.

TCA District 5 will have an official vote on February 21st, 2012 at the Quarterly Meeting.

Find more information about TCA District 5's elections in this article.

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