California Insurance Prompt Pay Law

This regulation is directly from the California State Department of Insurance and is specific for managed care/indemnity plans
 

If utilized properly, you will ensure your collections without having to beg and plead

from the desk of:
Mark Studin DC, FASBE(C), DAAPM, DAAMLP

The carriers have 30 working days and HMO's have 45 working days to pay or deny your claim. Anything beyond that will result in a default of the payment of your claim. A telephone call will fall on deaf ears. Therefore, create a paper trail with a demand for payment.

The Law:

Language for your complaint:

Dear Claims Examiner:

The services rendered were billed within the California insurance guidelines. It has now been beyond the 30 (or 45 for HMO's) working days allowed by California Prompt Pay Law, §§ 10123.13, 1371 (2000). Since you have violated this regulation, we can submit this entire claim for summary judgment or arbitration through our legal counsel.

We would like to resolve this issue without using legal counsel. If we do go to court, it will cost you both the amount of the claim and attorney fees with 15% interest annually, plus a $10 penalty per claim for not including the late interest as mandated by regulation §§ 10123.13, 1371 (2000).

WHAT IS THE SIGNIFICANCE?

As I shared, there are laws and regulations that insurers know all too well, but they bank on our not knowing them. As a result, they laugh all the way to the bank because we don't invoke the laws and regulations in place to reimburse us as legally required. I have been using these regulations and guiding offices for decades on how to understand and implement these laws, allowing doctors nationally to increase their collections by as much as 50% on a consistent basis.

By utilizing the power of the law, insurance carriers are now paying doctors interest for delayed payments as prescribed in most states which is the deterrent for delaying timely payment of our claims. In addition, we will be supplying language for you to use so that you can collect your fees timely. It is these regulations that the US Chiropractic Directory will be researching and providing for doctors in your state. We are providing this as a free service. Why?

WHY

The answer is research. As of 2011, there is no research that proves the basis of what we do, the true effects of the adjustment/manipulation. When we care for patients in our chiropractic offices, people get better, whether their problem is musculoskeletal, asthma, digestive issues, reproductive issues, pediatric issues, etc., and there is minimal to no research to certify in the scientific community that what we do is valid. In fact, there is no research that validates subluxation, the basis for chiropractic since 1895.

HOW TO GET THE INFORMATION

That doesn't mean chiropractic doesn't work or that we have to make anyone other than our patients happy...but...my goal is to realize 95% of the population under chiropractic care in my lifetime and after 30 years in chiropractic, the clear path towards the realization of that goal is "peer reviewed" research. We need more, it is costly and the government is not funding chiropractic anytime soon at a level significant enough to make a difference. Therefore, I am willing to provide doctors of chiropractic the power to collect more money, the knowledge to be more profitable and the action steps to realize that goal. The rules are the same for chiropractic, medicine, dentistry, etc. for insurance reimbursement and I have been successfully guiding multi-disciplines towards increased profitability for decades. My ulterior motive (yes, I have an ulterior motive) is that when chiropractors become more profitable and I ask for donations to support chiropractic research, there will be enough money to make a difference.

Although the Directory does offer paid memberships for any doctor who wants a preferred listing, there will be a free level of participation for any chiropractor to join and get the same insurance information. In addition, just as the preferred members do, the free members will have access to the curriculum vitae builder which is the only place anywhere to build your chiropractic CV in an admissible, professional format. There are no strings attached, no requirements to spend any money and it is not free for a limited amount of time. Basically, there are no games...It is free for those who choose this avenue and easy to enroll.

To get started:

1. Go to www.USChiroDirectory.com

2. Click on "Sign Up Today" on the homepage on the left hand side

3. Print the fax back form

4. Complete the form and fax it back

Once enrolled, to find the information:

1. Enter your username and password

2. Click on "Doctors" on the top toolbar

3. Scroll to "Doctors Consulting Site"

4. Click on "State Collection Regulations & Guidelines" on the left toolbar

5. Click on "California"

I look forward to getting your collections up.