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Patient Complaint Form

 

Patient Name:                        

Insurance Plan:          

Insurance ID:             

 

Department of Insurance

On Line Form 

https://cidonline.ct.gov/ccf/

  

Form Page

Re: Health Insurance Discrimination

            Non compliance with federal statute: PPACA Sec. 2706

Non compliance with state statutes: Sec. 38a-507, Sec. 38a-534, Sec. 38-591, Sec. 38a-1086

 

To whom it may concern,

 

I am filing a complaint against ____________________ insurance company for discriminating against my chiropractic doctor and his/her ability to deliver chiropractic services to the same degree medical services are available to me in my health insurance plan. I understand federal insurance law prohibits discrimination against providers and Connecticut insurance laws for individual and group policies require coverage for services rendered by a chiropractic doctor to the same extent coverage is provided for services rendered by a medical doctor. As a result, my liberty to select a physician who provides care consistent with my way of life is limited and my access to the full scope of effective evidenced based chiropractic services is limited.

 

Specifically my plan’s chiropractic benefit includes the following discriminatory policies:

1.     Chiropractic physicians are segregated from the physician categories in the benefits listings and descriptions. This limits the opportunities of patients to view chiropractic as a health care provider trained to the level of a physician

2.     Chiropractic doctors are not recognized, offered to subscribers and listed for primary care. Prospective and current patients lose opportunity and access to their services.

3.     Chiropractic doctors are not recognized, offered to subscribers and listed for specific specialty care (neurology, orthopedics, sports medicine and others). Prospective and current patients lose opportunity and access to their specialty services.

4.     Co-payment for chiropractic care is $______. The chiropractic co-payments must be to “the same extent” as medical doctor co-payments:

o   The co-payment for chiropractic generalist or primary care evaluation and management and consultation visits is _______ and therefore is not at “the same extent” as medical doctor primary care co-payments.

o   The co-payment for chiropractic specialist evaluation and management and consultation visits is _____. This may be considered reasonable only for the Evaluation and Management portion of the visits.

o   The co-payment for physical treatments provided by the chiropractic physician should be identical to physical therapy co-payments ordered by primary or specialty care medical doctors. These should be the same since the physical therapy co-payment is limited up to $30.00 per visit by statute. This favors a medical doctor’s treatment plan and fails to assure chiropractic coverage “to the same extent” as coverage is provided for a medical doctor.

 

 

 

 

5.     Chiropractic visits are limited to 20 per year. A medical or osteopathic doctor has no visit limits. This limits the opportunity for chiropractic doctors to provide care and patients to receive services to the same degree as care may be provided by a MD or DO.

6.     Chiropractic treatments are limited to neuromusculoskeletal conditions when they are not limited for medical and osteopathic doctors.

7.     Spinal manipulation for children less than 12 years of age is excluded when provided by a chiropractic doctor. This is not based upon reasonable and customary care or scientific evidence. Also, these limits are not imposed upon medical or osteopathic doctors.

 

The insurance company has imposed the following harms upon me:

 

 

 

 

 

 

 

 

 

 

 

 

 

Please accept my complaint and keep me informed of the status of this case.

 

Sincerely yours,

 

 

Patient’s name

 

Copies:            Office of Health Care Access

http://www.ct.gov/oha/site/default.asp

 

Office of the Attorney General

http://www.ct.gov/ag/cwp/view.asp?a=2093&q=555702

 

Connecticut Chiropractic Association

http://ctchiro.com/

 

Insurance Company: _____________________________

Web Address for complaints: ___________________________

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