New York's highest court of appeals has held that no-fault insurers cannot deny no-fault benefits where they unilaterally determine that a provider has committed misconduct based upon alleged fraudulent conduct. The Court held that this authority belongs solely to state regulators, specifically New York's Board of Regents, which oversees professional licensing and discipline. This follows a similar recent ruling in Florida reported in this publication.
VA Reimbursement for Chiropractic -- A Study in Perseverance
CLINTON, Missouri -- Disabled veteran Marvin Smith's condition was not responding to the medical treatment provided by the local VA hospital. Mr. Smith wanted the services of a chiropractor, but he needed to be reimbursed through the VA. Because the VA did not offer chiropractic services, Mr. Smith was presented with a riddle: How does one get reimbursed by the VA for chiropractic care?
Mr. Smith discovered that to be treated outside the hospital he needed a "fee base" card. To get a fee base card, Mr. Smith had to contact the nearest VA state representative and fill out a 1010 form.
Mr. Smith's search was not over. His chiropractor, Dr. Eberting needed to be registered with the VA reimbursement program. Dr. Eberting had to contact his U.S. Congressman, Ike Skelton to obtain this privilege. Dr. Eberting stated that to his knowledge his chiropractic clinic is the first such clinic in the nation given clearance to treat disabled veterans.
Oh, one more thing: Mr. Smith required a recommendation of medical necessity from an MD that stated he needed chiropractic care.
Do you remember the ram that kept butting the dam? Well, Mr. Smith and Dr. Eberting personify that determination to outflank a system that does its best to discourage patients from getting the kind of care they want.
Mr. Smith said, "If it wasn't for chiropractic care I would have been in a wheel chair and I thank God and Ike Skelton for the efforts it took to get this done."
Dr. Eberting has some advice when dealing with the VA: "The patient must not except the answer 'no' and if necessary, become bold in their requests. Remember who you are working with. The VA can be the coldest of heart and the deafest of ear. There is nothing more worth fighting for than for your rights. If we can do it, you can too."