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West Hartford Chiropractor | West Hartford chiropractic care | CT | Office Policy

Westside Chiropractic, LLC
 Providing Family Health Care- Naturally 

Richard Duenas, DC, DABCN, FICC

 
(860) 523-5833
557 Prospect Avenue,
West Hartford, CT 06105

Office Policy
 

OFFICE POLICIES

Appointments
First Visit Preparation
Telephone Message System
Cellular Phones
Urgent Care
Snow Policy
Fee Schedule
Payment of Services

Third Party Payer Policies


Appointments

Appointments may be made at the office, on the telephone and on my web site. Requests for appointments can be made through email. New patient initial appointments will require thirty to sixty minutes to address health history, current complaint and provide the appropriate examination for the condition. New patient health history forms are required. These forms may be completed ahead of the appointment to save some time. If unable to complete the forms before the appointment, please arrive fifteen minutes early to do so. Treatment may or may not be provided depending upon the circumstances involved. Established patients with new conditions may require extra time to address any changes in health status since last seen, address the current complaint and provide the appropriate examination for the condition. Certain case history forms may be required, depending on the type and cause of the condition. These forms may be completed ahead of the appointment to save some time. If unable to complete the forms before the appointment, please arrive fifteen minutes early. Treatment may or may not be provided depending upon the circumstances involved. Established patients receiving care on a regular basis may require five to thirty minute appointments depending upon their condition.

Appointments may be canceled with 24 hour notice. Exceptions can be made for illness, family emergencies and inclement weather. A charge will be made for missed appointments.


First Visit Preparation

Prior to reporting to the office you may need to complete a few items:

  1. Medical records - please obtain any medical records (physician reports or records, x-rays, MRI’s, CAT Scans, Bone Density Scans, blood and/or urine tests, etc.) to provide upon entry.
  2. Referrals - please obtain any referrals from a primary care physician or any other doctor as required by your health insurance company. Please send the referral form or script ahead of time or bring it on your first visit.
  3. Injury Report – If your condition is related to a school athletic injury or condition, motor vehicle collision, personal injury on another’s property or work related, you will need to report the injury to the appropriate authorities.

-         School athletic injuries: report to the athletic director and school’s athletic insurance company.

-         Motor Vehicle Collision: report to your insurance carrier and your attorney if necessary.

-         Personal Injury: report to the property owner and your attorney if necessary.

-         Work injury: report to your supervisor, company owner, workers’ compensation insurance company and your attorney if necessary.

  4.  Methods of payment – We accept many insurance plans, self pay and attorney liens when necessary.

-         Insurance plans: please provide us with your insurance plan information

-         Self pay: we accept cash, checks and credit cards

-         Attorney liens: accepted under certain circumstances when there are no other methods of payment and there is a firm case against another responsible party. Please notify your attorney to provide a Letter of Representation and Lien for your first visit.

On your first visit or returning after a prolonged absence or reporting after an accident (auto, work, personal) you will be asked to complete a comprehensive or brief health history, including past health problems, diet, exercise, occupation, and other information of importance such as an accident questionnaire if necessary. If you wish, you may obtain the appropriate paperwork from this web site. Please locate the paperwork for your situation, complete and return it to the office by mail or in person.

Upon entry, a case history will be conducted between you and your doctor. Be prepared to provide us with information that may help us help you. After this, an examination of your vital signs, musculoskeletal system, nervous system and/or organ systems may be undertaken. Special testing such as x-ray and laboratory work may also be utilized to determine your state of health.

Based upon your examination findings, a diagnosis will be made with the appropriateness of chiropractic treatment determined. Chiropractic care includes physical treatments such as adjustments, electric muscle stimulation, ultrasound, moist heat, ice, massage, exercise, sound and light therapy; biochemical treatments such as nutritional/dietary counseling, nutrient/botanical/herbal prescription and counseling about the prevention of disease, ergonomics, methods for living a healthy lifestyle, and encouragement for a positive mental attitude.

If treatment by other providers is necessary, whether entirely or as a compliment to chiropractic treatment, then a referral will be provided. You may not receive an adjustment at every appointment. The treatment you receive will be designed specifically for you - based on your symptoms and examination findings. 

Your progress will be carefully monitored. Your subjective improvement (the way you feel) as well as the objective findings (tests utilized by your doctor) will be noted, and your treatment plan may be modified to meet your changing condition. Communication between your doctor and other health care providers will be encouraged for your benefit.


Telephone System

From time to time during the working day, we may not be able to answer a call. Please leave a message with your name and phone number at the reception voice mail box and we will return your call as soon as possible. Throughout weekends and holidays we will check the machine for messages. Be sure to leave your name, phone number and a brief message at the reception voice mail box in order to provide you with prompt attention.


Cellular Phones

For the comfort of our patients and most especially for the comfort and focus of your own care, please turn off all cellular phones while in the office.


Urgent Care

For urgent care, we will schedule you as soon as possible. Please understand that those previously scheduled will have their appointments honored at the correct time. Please be patient as we will see you at the earliest opportunity.


Snow Policy

We make our best effort to get to the office through rain, sleet and snow to provide for your health care needs. But if safety conditions worry you, please call and let us know you will not make your appointment. We would like to know that you are safe!


Payment of Services

Fees due to our office are the responsibility of our patients. Many services provided will be paid by a third party such as general health insurer, auto insurance or workers’ compensation. With all third party systems of payment, the contracts are between you and the third party and in some cases between our office and the third party. Any service which the third party deems as uncovered is entirely your responsibility and may include the deductible, co-insurance, co-payment and uncovered services. Missed appointments will be charged to you unless 24 hours notice is given. We participate with many major health insurance plans. Always keep in mind, to assure you receive the care you need, financial arrangements can be made to meet your budget plans.

Third Party Payer Policies

 General Health Conditions

Conditions related to your general health care may be paid by your health insurance carrier or yourself. With health insurance plans, please keep in mind that coverage depends upon the contract signed by you, the employer sponsor, government agency (Husky, Medicaid, Medicare) and/or the contract signed by this office. Many plans are different and must be reviewed by you and this office to assure a complete understanding of coverage and limitations. Please keep in mind that insurance plans do not determine the need for care and should not be solely depended upon to decide if you are to pursue care in this office. The decision to pursue care is ultimately your responsibility given your understanding of the type of care we provide. Balance from deductibles, co-payments and uncovered services are expected on the day of service. Durable supplies (braces, pillows, supports, exercise equipment) and non-durable supplies (vitamins, creams) are usually not covered by insurance. We require payment for supplies at the point of sale and accept cash, check and credit card.

Participating Health Plan List (partial list)*

Aetna

 Connecticare

NE Direct Health
Anthem BC/BS

Medicare

Oxford
CIGNA
           with Stratose or Prime Health Service      
networks only
       Medicare HMOs     
United Healthcare
        

 

Medicare Advantage Plans: Medicare Blue, Connecticare, United Healthcare

*Participation status is subject to change without notice. Please confirm with the front office for participation status with your plan.

 

Motor Vehicle Collision (Accident) Conditions

For conditions related to motor vehicle collisions where you are the driver, passenger or a pedestrian, services may be paid by your automobile insurance carrier, the drivers automobile policy, your health insurance, yourself or upon settlement of a claim against a negligent party. In any event, the following steps must be taken:

  1. Obtain the declarations page of your auto insurance policy and call your insurance agent or insurance company directly to clarify the provisions of your automobile insurance policy. You will need Medical Expense Benefits (MEB’s) to assure payment for the services we provide. If you do not have MEB’s then you must obtain a letter from the insurer stating this fact as soon as possible.
  2. Present your automobile insurance policy to the office. If you do not have Medical Expense Benefits, we may submit your claims to your health insurance carrier. In order to do this we need a note from your Auto Insurance carrier stating that you do not have Medical Expense Benefits. Also, your health insurance benefits must be verified by this office and you. All provisions of your health plan must be followed. (See above - General Health Conditions)
  3. Notify our staff how you wish to pay for your care when there is partial or no automobile or health insurance coverage. We accept cash, check and credit card.
  4. Notify your attorney, if one is retained, that you are under care in this office. We will need a letter of representation to keep your attorney updated on the status of your condition. If you do not have MEB’s or health insurance to cover your costs then we may accept a lien on your case only for services related to treatment. It is our policy that the costs for administrative services, supplies and equipment are paid on the same day of service.

 

Medical Expense Benefits

If you’re involved in a motor vehicle collision and receive services we must receive your automobile insurance policy information as soon as possible to determine if medical expense benefits are available on your policy. This is essential whether you or another person is responsible for causing the collision. If there are medical expense benefits on your policy then all bills will be paid by your automobile insurance company up to the limits of the policy. Purchase of supplies and equipment are excluded. If medical expense benefits are not available, then we require a letter stating medical expense benefits are not available. We need this letter to assure benefits are not available and to submit the bills to your health insurance company. Health insurance companies do not pay for motor vehicle, work or slip and fall related injuries unless there is a letter stating insurance is not available. The other person’s automobile (liability) insurance policy will not pay for your treatment during the course of treatment. They may make payment for your claim when all treatment is completed. This is arranged between you or your attorney and the insurance company. If you have an attorney who provides a letter of representation and letter of protection, then your bills will be sent to the attorney. Please understand all attorneys and/or cases are not accepted. We expect to receive full payment of services upon resolution of your case. If you do not have health insurance or an attorney, then all bills will be your direct responsibility with payment made in advance or at the time of treatment.

It is very important you have Medical Expense Benefits on your automobile insurance policy:

  1. Health insurance plans usually have a deductible typically ranging from $250 to $5,000 that must be met before reimbursement of services. Automobile insurance plans usually have no deductible.
  2. Health insurance plans may require a co-payment (fixed amount – usually $20 to $45) for each visit. Automobile insurance plans usually have no co-payment.
  3. Health insurance plans may require a co-insurance (percentage amount – usually 20% - 30%) for each visit. Automobile insurance plans usually have no co-insurance.
  4. Health insurance plans usually require treatment plans that are reviewed and authorized for visit number, duration of care and services authorized for treatment. Typically, visit authorization, services authorized and duration of authorization is kept low, thus limiting necessary treatment. Automobile insurance plans do not require this.
  5. Motor vehicle collisions usually result in multi-region and system injuries which necessitate extensive care over an extended period of time. Injured tissue, depending on the degree of injury, will require a few weeks to one full year for proper healing and re-establishment of body function. Health insurance plans typically categorize these injuries in the same manner as regular daily living type of injuries which involve fewer tissues with less severity. The reasonable and necessary number and type of treatments required to care for multiple region injuries are usually not authorized. Automobile insurance plans only process these types of injuries and are required to pay for reasonable and necessary care.
  6. Health insurance policies are more restrictive than automobile insurance in terms of reimbursement of services thus limiting the opportunity for you to receive necessary services. Automobile insurance plans provide reasonable payment which do not limit opportunity for you to receive necessary services
  7. The effects of the Affordable Care Act on health insurance policies include increased premiums, deductible, co-payments and co-insurance along with reduced service, visit authorization and providers. If you rely on health insurance for an automobile related condition, your options are substantially limited.

 

Medical Expense Benefits are necessary. Health insurance plans DO NOT provide the same coverage as the Medical Expense Benefits policy of automobile insurance. Medical Expense Benefits are very important for assuring good health care if you have a motor vehicle related injury.

 

Personal Injury

For conditions related to personal injury such as slipping and falling on public or private property services may be paid by the liability carrier, your health insurance or yourself. In any event the following steps must be taken.

  1. Notify our staff how you wish to pay for your care. We accept cash, check and credit card.
  2. Bring in your health insurance policy for verification of benefits. (See above - General Health Conditions)
  3. Obtain the liability insurance policy information from the owner of the property where your injury occurred.

If you have an attorney, notify him/her that you are seeking care in this office and that we will need a letter of representation to keep them updated on the status of your condition. If you do not have health insurance to cover the costs for care and would like us to wait for your case to be settled and accept a lien on your case, then be advised that if we accept the case as a lien, it is our policy to accept a lien letter only for services related to treatment. It is our policy that the costs for administrative services and supplies and equipment are paid during the course of care.

 

Workers’ Compensation

For conditions related to work injuries, you must report your injury to your supervisor and your case must be accepted by your employer. Your employer may send you to a doctor in their managed care network. You are required to visit this doctor for the initial examination. After this visit, you may choose to visit any other doctor within the employer’s workers’ compensation managed care plan. If there are no doctors of a particular discipline (i.e. chiropractic) or specialty in the employer’s managed care plan, then you may choose any doctor licensed in the State for that particular discipline or specialty. This means the panel is open to any doctor of the particular discipline or specialty. You should choose which doctor you want to care for your condition as soon as possible. Your employer must provide you with a complete list of providers on the plan. Be sure to ask for the complete provider list as well as the name address and telephone number of the workers’ compensation insurance carrier. If your employer contests your claim, then you must submit your claim to your health insurance carrier with a letter from the workers’ compensation carrier denying the work injury. Patient balances from deductibles, co-payments and uncovered services are expected on the day of service. Durable supplies (braces, pillows, supports, exercise equipment) and non-durable supplies (vitamins, creams) may not covered by workers’ compensation insurance. We accept cash, check and credit card.

Participating Workers’ Compensation Plan List (partial list)*

State of Connecticut (Gallagher Bassett)    
Comprehensive Rehabilitation Network
Board of Education – Hartford
Corvel
Board of Education – West Hartford
First Health
Connecticut Children’s Medical Center
Focus
Hartford Hospital
Gallagher Bassett
Saint Francis Hospital
Kemper
UCONN Health Center
The Hartford
CIRMA care
Tavelers
Connecticut Hospital Association
Wausau

 *Participation status is subject to change without notice. Please confirm with the front office for participation status with your plan.

For specific information about workers’ compensation and your rights access this information from 1, 2 or 3:

  1. http://www.ct.gov (select: Government / State Government Web Sites / Executive Branch / Workers’ Compensation Commission (under Agencies header)
  2. http://wcc.state.us/
  3. http://wcc.state.ct.us/gen-info/if-injured/preface.htm