Tri-County Chiropractic

January 12, 2016Dear Sir/Madam:We are in receipt your response dated 12/30/with regard to the above referenced complaintWe are responding to such response.Response to paragraph 1:We understand that you were under the impression that an adjustment was included in the special The special clearly states it is not included but we will reiterate with our staff what is included and not included in said specialOur staff is fully trained on the exact nature of our internet offersIt is usual and customary for our facility to allow a patient who chooses to receive an adjustment, when recommended by one of our doctors after examination and consultation to have an adjustment performedAgain our website special clearly indicates the inclusion of examination, consultation and one hour massage for $39,(see attached)The allegation of “bait and switch” is clearly unfounded as illustrated by the copy of the internet offerWe will however review our procedure with our staff The definition of a “bait and switch” tactic is as such:A dishonest marketing tactic in which a marketer advertises a very attractive price/rate/term that is really a teaser rate meant to attract customers.Neither the examination, consultation nor the one hour massage were billed to insurance* The patient received an examination, a consultation and a one hour massageThey paid $The patient also received a full spine adjustment and dynamic activities performed by our staffThose billables were submitted to insurance and applied to her deductibleThe definition of “deductible” is as such:In an insurance policy, the deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expensesWith regard to the paperwork, the doctor conducted an exam and consultationIt is important that the patient fill out all medical information to conclude the best recommendationWe do not distribute a letter to patients “implying a causal relationship between the completion of the required intake and that your bill would be more than triple”The only office forms we have are for the sole purpose of patient history, insurance, HIPPA and informed consent (see attached)The cost for the first visit, in this case, was $62.,for the adjustment and stretching/muscle workThis is a usual and customary fee for these services in the Pottstown areaThey are also in compliance with Medicare's relative value unit which determines a physician’s fee schedule.Response to paragraph 2It is usual and customary for this office to send out statements to a patient and if no response or payment, the account is forwarded to a collection agencyWe were in verbal contact with the patient’s husband on at least two occasionsHis concern was that he thought this should not have been applied to the patient’s deductibleOur billing manager, Angela, did contact the insurance company on his behalf and confirm with the insurance company that it processed correctlyAngela and the patient's husband did talk againHe wanted to get this cleared up and stated this so his wife could come back to this office for treatmentAt no time did he mention a concern with regard to treatment or a "bait and switch” concern.In addition, we did received messages from the patient’s husband and, not including the above mentioned conversations, several messages were returned to the phone number that was given to the front deskWe do not leave detailed messages with regard to a patient’s account or health on any voicemail due to privacy.It is usual and customary of this office to address any and all concerns or questions with regard to a bill or how an insurance company processes claimsWe do not send any patient’s account to collections if there are ongoing conversations with regard to such.Response to paragraph 3:As with any doctor’s office, there is no guarantee that any treatment will result in a positive physical outcomeFor example, if a blood pressure medicine is prescribed by a patient’s physician and fails to lower a patient’s blood pressure, the doctor will simply prescribe another blood pressure medicineThere are many different alternatives for patients to receive relief from pain Not every method works for every patient Effectiveness of treatment is determined by the subjective changes stated by the patient in conjunction with the objective findings of the doctorTreatment plans in chiropractic care, similar to those in physical therapy, require at times several visits per week for several weeks to correct mechanical dysfunction and reduce pain.Our treatment protocols consist of a variety of manual and mechanical modalities designed to reduce pain, restore range of motion, correct mechanical disturbance and correct aberrant movement patternsEach of these modalities is performed by our physicians or our support staff under the physicians’ direction.In conclusion, we will go over our procedures and specials with our staff to make sure there is no misunderstanding how this office performsIn addition, we stand by billing practices and marketing specialsWe also stand by the treatment that was received by this patient.We were contacted by your insurance company on 10/17/requesting medical recordsThis is a common practice for insurance companiesThe letter does not state that this was an investigation nor does it state that the claim will be deniedThe insurance company received the notes on 10/26/We have contacted the insurance company with regard to this request and they have stated that medical records request concludes within days, however, the insurance company has nothing on file as to the conclusionThe insurance company stated today that is will take up to another days.We understand you feel that there was confusion at your first visitAs such, we will consider reversing the charges for the 2/25/date of service for a *** and ***, We would like to come to an understanding and resolution with regard to your complaint and would like you to contact the owner of the Pottstown office, DrChristine T***Patient care is our utmost importance and we are very transparent with our billing procedures.We will honor the request to not contact the patient or her husband.Regards,DrChristine T

January 12, 2016Dear Sir/Madam:We are in receipt your response dated 12/30/with regard to the above referenced complaintWe are responding to such response.Response to paragraph 1:We understand that you were under the impression that an adjustment was included in the special The special clearly states it is not included but we will reiterate with our staff what is included and not included in said specialOur staff is fully trained on the exact nature of our internet offersIt is usual and customary for our facility to allow a patient who chooses to receive an adjustment, when recommended by one of our doctors after examination and consultation to have an adjustment performedAgain our website special clearly indicates the inclusion of examination, consultation and one hour massage for $39,(see attached)The allegation of “bait and switch” is clearly unfounded as illustrated by the copy of the internet offerWe will however review our procedure with our staff The definition of a “bait and switch” tactic is as such:A dishonest marketing tactic in which a marketer advertises a very attractive price/rate/term that is really a teaser rate meant to attract customers.Neither the examination, consultation nor the one hour massage were billed to insurance* The patient received an examination, a consultation and a one hour massageThey paid $The patient also received a full spine adjustment and dynamic activities performed by our staffThose billables were submitted to insurance and applied to her deductibleThe definition of “deductible” is as such:In an insurance policy, the deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expensesWith regard to the paperwork, the doctor conducted an exam and consultationIt is important that the patient fill out all medical information to conclude the best recommendationWe do not distribute a letter to patients “implying a causal relationship between the completion of the required intake and that your bill would be more than triple”The only office forms we have are for the sole purpose of patient history, insurance, HIPPA and informed consent (see attached)The cost for the first visit, in this case, was $62.,for the adjustment and stretching/muscle workThis is a usual and customary fee for these services in the Pottstown areaThey are also in compliance with Medicare's relative value unit which determines a physician’s fee schedule.Response to paragraph 2It is usual and customary for this office to send out statements to a patient and if no response or payment, the account is forwarded to a collection agencyWe were in verbal contact with the patient’s husband on at least two occasionsHis concern was that he thought this should not have been applied to the patient’s deductibleOur billing manager, Angela, did contact the insurance company on his behalf and confirm with the insurance company that it processed correctlyAngela and the patient's husband did talk againHe wanted to get this cleared up and stated this so his wife could come back to this office for treatmentAt no time did he mention a concern with regard to treatment or a "bait and switch” concern.In addition, we did received messages from the patient’s husband and, not including the above mentioned conversations, several messages were returned to the phone number that was given to the front deskWe do not leave detailed messages with regard to a patient’s account or health on any voicemail due to privacy.It is usual and customary of this office to address any and all concerns or questions with regard to a bill or how an insurance company processes claimsWe do not send any patient’s account to collections if there are ongoing conversations with regard to such.Response to paragraph 3:As with any doctor’s office, there is no guarantee that any treatment will result in a positive physical outcomeFor example, if a blood pressure medicine is prescribed by a patient’s physician and fails to lower a patient’s blood pressure, the doctor will simply prescribe another blood pressure medicineThere are many different alternatives for patients to receive relief from pain Not every method works for every patient Effectiveness of treatment is determined by the subjective changes stated by the patient in conjunction with the objective findings of the doctorTreatment plans in chiropractic care, similar to those in physical therapy, require at times several visits per week for several weeks to correct mechanical dysfunction and reduce pain.Our treatment protocols consist of a variety of manual and mechanical modalities designed to reduce pain, restore range of motion, correct mechanical disturbance and correct aberrant movement patternsEach of these modalities is performed by our physicians or our support staff under the physicians’ direction.In conclusion, we will go over our procedures and specials with our staff to make sure there is no misunderstanding how this office performsIn addition, we stand by billing practices and marketing specialsWe also stand by the treatment that was received by this patient.We were contacted by your insurance company on 10/17/requesting medical recordsThis is a common practice for insurance companiesThe letter does not state that this was an investigation nor does it state that the claim will be deniedThe insurance company received the notes on 10/26/We have contacted the insurance company with regard to this request and they have stated that medical records request concludes within days, however, the insurance company has nothing on file as to the conclusionThe insurance company stated today that is will take up to another days.We understand you feel that there was confusion at your first visitAs such, we will consider reversing the charges for the 2/25/date of service for a *** and ***, We would like to come to an understanding and resolution with regard to your complaint and would like you to contact the owner of the Pottstown office, DrChristine T***Patient care is our utmost importance and we are very transparent with our billing procedures.We will honor the request to not contact the patient or her husband.Regards,
DrChristine T

Dear *** ***,
Thank you again for your assistance with this matter. I accept the offer of a partial refund. I believe we made the same offer for a successful resolution with the company months ago which the billing manager rejected. My husband will call the office by the end of the business week with his credit card information so that they can process the partial refund. Please do not close our case until I can confirm that the refund has been issued
Thank you,
*** *** ***

December 22,2015Dear Sir/Madam:
We are in receipt your letter dated 12/14/15 with regard to the above referenced complaint. We are responding to such complaint.
The complainant states we were running a new patient special on our website. The special states $39.00 for...

an exam and consult with the doctor and a one hour massage (enclosed). This does not include an adjustment.  They are not obligated to get adjusted by the doctor to receive the one hour massage. The patient did receive the exam, consult and one hour massage on the first visit which was on February 25, 2015 and the special was honored. The insurance code associated with an exam by a doctor is a 99 code. This code was not billed to the insurance company because it is included in the $39.00 special (enclosed). However, the patient did choose to be adjusted that day and provided insurance information for us to bill the services rendered. The patient also filled out all the intake forms allowing us to bill her insurance (enclosed).On her first day, February 25, 2015, the patient’s intake paperwork states the reason for her visit is she has extreme neck and should pain. She also stated she had mid and low back pain.  She was given an orthopedic examination over her cervical and lumbar region. The cervical exam consisted of: cervical range of motion, [redacted] Test, [redacted], Shoulder Depression Test and Foraminal Compression Test. She had a positive Shoulder Depression Test, a positive [redacted] sign, a positive [redacted] Compression Test bilaterally and positive Foraminal Compression test bilaterally.
In addition, she had a lumbar test which included a Straight-Leg Raise Test which was within normal limits.  More extensive notes are available if requested.  
During her first visit, she stated her pain level to be 7 out of 10 for her neck, mid and low back.  It is noted her cervical, thoracic and lumbar regions were adjusted and moved well.  The code that was billed was a [redacted], which is defined as an adjustment of 3-4 regions of the spine.  She also received muscle therapy and/or stretching.  The code billed is [redacted], which is 8-22 minute code defined by CMS.  The patient also received some muscle therapy ([redacted]) which was not billed to insurance.  Enclosed you will find a copy of the explanation of benefits which shows what was billed to the complainant's insurance company by Tri County Chiropractic.  
The second visit for this patient was 3/6/15.  She stated her pain level was 6 out of 10 for her neck, mid and low back.  The patient stated she was doing better until her symptoms became aggravated.  She improved slightly for three days after her last appointment but her discomfort had increased.  Post isometric relaxation stretching and passive manual therapies were performed ([redacted]) and diversified adjustments were performed and all vertebral segments moved well ([redacted]).  
On the third visit, she stated her pain level to be 5 out of 10 for her neck, mid and lower back.  Massage therapy and post isometric relaxation stretching and passive manual therapies were performed ([redacted]) and diversified adjustments and all vertebral segments moved well ([redacted]).  In addition, an anterior rib 1 adjustment was performed to correct intersegmental dysfunction of the first costovertebral joint ([redacted]).  
The patient did pay $39.00 on the 2/25/15, $20.00 on 3/6/15 and $20.00 on 3/13/15 due to her insurance coverage.  The insurance benefits that applied to chiropractic coverage were subject to a deductible and coinsurance.  The payments that were made were credited to the patient's account.  Once the insurance processed these dates of service, a bill was sent to the patient was dated 4/28/15.  In May, the patient's spouse called and spoke to our billing manager.  He questioned the bill and the billing manager, as a courtesy, stated she would call the insurance company to make sure it was processed correctly.   As per the insurance company, it was processed correctly.  A second statement was sent out on 6/25/15.  On 7/7/15, the patient's spouse called again and spoke to the billing manager.  The only concern with him was how the insurance processed these claims.  At no time during any phone call were there any complaints regarding treatment.  He stated he wanted to get this resolved because his wife wanted to make another appointment.  Since there was no payment received, our billing manager reached out to the patient on 8/8/15 and 8/21/15 and left messages as a courtesy.  The complainant states there were several attempts to contact this office with no resolution.  There have been at least two times this was addressed with our office and the patient's spouse.  
On 12/11/15, the patient's spouse called the office and paid the bill of $170.00.
In conclusion, the "bait and switch" that was stated in the complaint is without validity.  All payments were performed.  Let it be also noted that this office did not send this account to collections even though no payment was received for 8 months after the first statement and the courtesy of calling the insurance company for the patient.  It is ultimately the patient's responsibility to know and understand their benefits and to call them for any questions with regard to processing dates of service.  
Regards, 
Dr. Christine T.

December 22,2015Dear Sir/Madam:We are in receipt your letter dated 12/14/15 with regard to the above referenced complaint. We are responding to such complaint.The complainant states we were running a new patient special on our website. The special states $39.00 for an exam and consult with...

the doctor and a one hour massage (enclosed). This does not include an adjustment.  They are not obligated to get adjusted by the doctor to receive the one hour massage. The patient did receive the exam, consult and one hour massage on the first visit which was on February 25, 2015 and the special was honored. The insurance code associated with an exam by a doctor is a 99 code. This code was not billed to the insurance company because it is included in the $39.00 special (enclosed). However, the patient did choose to be adjusted that day and provided insurance information for us to bill the services rendered. The patient also filled out all the intake forms allowing us to bill her insurance (enclosed).On her first day, February 25, 2015, the patient’s intake paperwork states the reason for her visit is she has extreme neck and should pain. She also stated she had mid and low back pain.  She was given an orthopedic examination over her cervical and lumbar region. The cervical exam consisted of: cervical range of motion, [redacted] Test, [redacted], Shoulder Depression Test and Foraminal Compression Test. She had a positive Shoulder Depression Test, a positive [redacted] sign, a positive [redacted] Compression Test bilaterally and positive Foraminal Compression test bilaterally.In addition, she had a lumbar test which included a Straight-Leg Raise Test which was within normal limits.  More extensive notes are available if requested.  During her first visit, she stated her pain level to be 7 out of 10 for her neck, mid and low back.  It is noted her cervical, thoracic and lumbar regions were adjusted and moved well.  The code that was billed was a [redacted], which is defined as an adjustment of 3-4 regions of the spine.  She also received muscle therapy and/or stretching.  The code billed is [redacted], which is 8-22 minute code defined by CMS.  The patient also received some muscle therapy ([redacted]) which was not billed to insurance.  Enclosed you will find a copy of the explanation of benefits which shows what was billed to the complainant's insurance company by Tri County Chiropractic.  The second visit for this patient was 3/6/15.  She stated her pain level was 6 out of 10 for her neck, mid and low back.  The patient stated she was doing better until her symptoms became aggravated.  She improved slightly for three days after her last appointment but her discomfort had increased.  Post isometric relaxation stretching and passive manual therapies were performed ([redacted]) and diversified adjustments were performed and all vertebral segments moved well ([redacted]).  On the third visit, she stated her pain level to be 5 out of 10 for her neck, mid and lower back.  Massage therapy and post isometric relaxation stretching and passive manual therapies were performed ([redacted]) and diversified adjustments and all vertebral segments moved well ([redacted]).  In addition, an anterior rib 1 adjustment was performed to correct intersegmental dysfunction of the first costovertebral joint ([redacted]).  The patient did pay $39.00 on the 2/25/15, $20.00 on 3/6/15 and $20.00 on 3/13/15 due to her insurance coverage.  The insurance benefits that applied to chiropractic coverage were subject to a deductible and coinsurance.  The payments that were made were credited to the patient's account.  Once the insurance processed these dates of service, a bill was sent to the patient was dated 4/28/15.  In May, the patient's spouse called and spoke to our billing manager.  He questioned the bill and the billing manager, as a courtesy, stated she would call the insurance company to make sure it was processed correctly.   As per the insurance company, it was processed correctly.  A second statement was sent out on 6/25/15.  On 7/7/15, the patient's spouse called again and spoke to the billing manager.  The only concern with him was how the insurance processed these claims.  At no time during any phone call were there any complaints regarding treatment.  He stated he wanted to get this resolved because his wife wanted to make another appointment.  Since there was no payment received, our billing manager reached out to the patient on 8/8/15 and 8/21/15 and left messages as a courtesy.  The complainant states there were several attempts to contact this office with no resolution.  There have been at least two times this was addressed with our office and the patient's spouse.  On 12/11/15, the patient's spouse called the office and paid the bill of $170.00.In conclusion, the "bait and switch" that was stated in the complaint is without validity.  All payments were performed.  Let it be also noted that this office did not send this account to collections even though no payment was received for 8 months after the first statement and the courtesy of calling the insurance company for the patient.  It is ultimately the patient's responsibility to know and understand their benefits and to call them for any questions with regard to processing dates of service.  Regards, Dr. Christine T.

Dear [redacted],Thank you again for your assistance with this matter.  I accept the offer of a partial refund.  I believe we made the same offer for a successful resolution with the company months ago which the billing manager rejected.  My husband will call the office by the end of the business week with his credit card information so that they can process the partial refund.  Please do not close our case until I can confirm that the refund has been issued.
Thank you,
[redacted]