Assault Upon Chiropractors Fended Off
When one of the nation’s largest health insurers decided to audit payments previously made to all out-of-network / non-participating chiropractors, a group of targeted chiropractors were referred to Mr. Quadrino for help.
Out of network / non-participating providers have even more leverage that in-network doctors. While health insurers’ letters try to make it seem as though they have the “right” to review previously paid claims or the “obligation” to do so, neither is true.
In all of the States, we have yet to see a law that authorizes an audit of previously paid claims. In fact, not only would such a law be overtaken and superseded by the federal law ERISA, there are no such laws on the books that we are aware of, in any event.
So without a participating provider agreement, no State law to back up an insurer’s audit demands, and federal law and ERISA claims regulations in the doctor’s favor, a non-participating provider needs to be properly armed and represented by knowledgeable counsel when facing such audit demands.
With the group under attack here, QLG responded with a full scale explanation of all of the applicable federal law that QLG believes prevents a health insurer from obtaining a refund of monies previously paid on health plan claims.
After all of the communications were sent by Mr. Quadrino and the applicable law made clear, the insurance company walked away from its audit demands and refunds demands, with success achieved for the group of chiropractor clients.