Successful people ask better questions, and as a result, they get better answers.
Frequently Asked Questions
Q: What questions should I ask my insurance company when I inquire about my out-of-network options?
A: You can ask your payer to provide you with answers to the following questions:
1. What is my out-of-network deductible?
2. Is my out-of-network deductible separate from my in-network deductible?
3. What is my coinsurance?
4. What is the maximum amount of out-of-pocket expenses I will be required to pay annually?
Q: I can usually file my own claims, but I've had more trouble lately. Is it worth it to use your biller to file for me?
A: Claims filed by an experienced biller will naturally be filed more quickly and with less potential for mistakes. When you file a claim by mail, the processor must manually enter into the insurance company’s computer system the following information: the treating facility; the facility address; the name of the care provider; ID numbers for the patient, facility and provider; service codes, and the corresponding diagnosis codes. In sum, there is a lot of information that must be entered, which opens the door for errors. For example, frequently insurance company claim processors code the diagnoses checked off on your fee slip from left to right, instead of properly connecting each diagnosis code with its corresponding treatment code. Without logical procedure code/diagnosis pairings, your claim will be automatically rejected.
That said, C.I.M. makes no guarantee that opting for filing assistance will ensure complete or even partial reimbursement. If there are no out-of-network benefits, it will be difficult. It is in the financial interest of the payers to deny claims.
When your claim is professionally filed, however, it is done so in your insurance carrier’s preferred format, either electronically or on the “CMS 1500 Form.” Treatment and diagnostic codes are correctly matched and ranked. These claim forms are almost always electronically “read” and automatically processed. The result is that most of the claims we process are decided and paid quickly.
Q: I booked a 45 minute appointment but got charged for 50 minutes this time - can you explain this?
A: As described above, all clinical charges at C.I.M. are based on time, rounded to the nearest 5 minutes, so the short answer is that if you went over 45 minutes, this would have been rounded up to the 50 minute charge.
The long answer is more involved. It is actually rare for a scheduled face-to-face time of an appointment to take exactly the time allotted. When the visit begins, a timer is started, and when the visit ends, it is stopped - and whether it is longer or shorter than anticipated, the charge will reflect that. The purpose of this policy is to ensure that both parties feel they have the space necessary to achieve the best efficacy - especially if the doctor determines the case deserves more time (part of Dr. McClanahan's leaving the system in the first place). At C.I.M. we have no intention to irritate you or quibble over a few seconds or minutes here and there - we are happy to have a discussion.
Q: How did C.I.M. come up with their rates? Are they competitive?
A: Dr. McClanahan spent a good deal of time research the rates of the regional payers, including Medicare allowable charges, and came up with rates that are below what local clinics typically charge. For example, if the various codes payed by a major local insurer were averaged between all the various visit codes, the rate would be ~$390/hour. Remarkably, that nagging cough you saw the doctor for, which you were told was a virus and took 15 minutes or less, was billed at a rate of $540/hr. Dr. McClanahan's tiered approach is added complexity for him, but hopefully greater affordability for you.
In the long run, a more affordable solution for many will be the Classes and Workshops that are mentioned, each of which will recycle a number of times throughout the year.
Q: Does C.I.M. offer financing?
A: Not at this time. However there are a few groups who will help with this and not charge the laughable rates of a credit card. Please look at this website for more information: www.mlendfinance.com
Q: Can you explain a bit more about why you cannot take Medicare? It makes no sense that the government would tell me where I can and can't spend my own money.
A: I 100% agree and was shocked to learn the myriad ways I can be fined or go to jail simply for giving someone what they are asking and paying for. This, however, is where medicine is different than some other trade, such we have legislated that a physician must declare if he/she is going to participate in Medicare or not - a decision which transcends all practice settings (e.g. C.I.M. vs urgent care) and is a binding decision for 2 full years. Anyway, I am now boring myself into a stupor, so if you are not asleep, feel free to read more here.
I hope one day to remedy this situation, but there are numerous x-factors and unknowns, so for now I would like to keep my medical license, which means we are stuck in this situation. Please join me in a class if this applies to you!
Q: Will my out-of-network benefits pay for Osteopathic Manual Medicine?
A: It depends on your benefits, however this is considered a legitimate medical procedure by nearly all major payers. Thus, if you have out-of-network benefits that help with C.I.M. at all, there is a good chance this will be a covered service.
Q: Will my out-of-network benefits pay for prolotherapy?
A: No - prolotherapy is basically never covered by any insurance. It is, however, eligible for applying HSA and FSA funds.
Q: Does C.I.M. prescribe meds to help with pain, or drugs like Suboxone & methadone?
A: No. We are not equipped to meet the stringent requirements to prescribe opioids or related controlled substances. Our aim is to address pain or other symptoms so thoroughly that medications like these are no longer needed. In the short term, however, they often are, which is why Dr. McClanahan requires an active relationship with a prescribing physician (PCP, Pain Mgmt, etc) be in place. Buprenorphine is a remarkable medication, and if you have opioid dependence and an interest in reducing or stopping opioids, this may be highly effective, if managed appropriately. Let Dr. McClanahan know this and he will direct you accordingly.
Q: Does C.I.M. recommend or dispense marijuana for pain?
A: No. This is currently not legal in any way in the state of Tennessee, or anywhere on a federal level. Cannabidiol (CBD) is legal and widely accessible now - perhaps you should research it and give it a try. Tetrahydrocannabinol (THC) is the psychotropic substance in marijuana - this is not legal. I have opinions on this matter at large that I am happy to share in person, but I have no "connections", access to, dispensing capacity (CBD or THC), or professional interest in prescribing this at this time and am plenty effective at treating chronic pain otherwise.