PLEASE TAKE NOTE:Dr. PRESS takes his name and reputation VERY seriously. Please do not ask us to create fictitious visits to "Cover Deductibles", or to use someone else's insurance coverage, or any other scheme which may constitute a violation of the criminal statutes in any State or Federal jurisdiction
Due to Federal laws, some of what is presented here may not apply to your program if you are in MediCare or MedicAID.
IF YOU HAVE MAJOR MEDICAL INSURANCE
We accept all regular insurance plans which allow you free choice of physician including
Aetna
Blue Cross/Blue Shield
Guardian
Multi-Plan
Oxford Freedom Plan
United Health
and MOST others.... if not listed here, please call 201-569-1444 to confirm
NOTE: A - Some plans (e.g., Blue Cross/ Blue Shield) continue to immorally, and possibly illegally discriminate against Chiropractic Physicians, refusing to cover the fee for our intake exam, which as Physicians is required by law and standards of professional practice.
NOTE: B - If you have a deductible above $500.00/person for the year, please see the section on "uninsured below". EXCEPT if you have a co-pay for specialists or $30 or more/ visit, then see the "HMO" section below
IF YOU WERE IN AN AUTO ACCIDENT.....
*In the State of New Jersey, we have a NO FAULT law. This is to protect you from having to wait years to know the outcome of a lawsuit if someone caused your injury. Or not. In any event, your OWN insurance MUST cover your claims. Pursuant to State Statutes your insurance premiums may NOT be raised for any reason to do with your medical bills resulting from your accident. Thus it does NOT matter if you were at fault or not in the accident. You premiums MAY be raised only if the accident is considered by the carrier (the carriers have a procedure for determining this themselves) to be an "at fault" accident, whether you have $1.00 or $1,000,000.00 in medical bills.
WARNING: You have only TEN days from the date of the accident to get care without having to obtain a pre-authorization from your auto carrier. PLEASE call us right away! If the ten days have elapsed...because you did not realize that you were hurt and needed help, please contact us ANYWAY.... ASAP, so that we can process all the paperwork required to get you covered.
If you were not driving, or if you did not own a vehicle at the time of the accident, then you MUST be covered by one of the following:
A.- If NEITHER you, nor anyone residing with you (related to you by blood or marriage) at the time of the accident owned a car, then and only then the insurance for the owner of the vehicle in which you were riding at the time of the accident must cover you. You will need to sign a legal affidavit of no insurance to this effect for us to process a claim in this way.
B.- If ANYONE residing with you (related to you by blood or marriage) at the time of the accident owned a car, then THEIR insurance MUST be billed for your services, and remember, their premiums cannot be raised because such an accident cannot be construed as "at fault" for them!
Example: If your grand niece, who does not own her own car, is living with you for even a few days, and she goes out one evening, and hitchhikes, and the guy who picks her up stops at a light, and gets hit in the rear, then YOUR auto policy probably has to pay HER bills. Key words: She was LIVING with you: Niece (related by blood); and did NOT OWN a Car. It get more complicated if she had a car, but was not insured in NJ - ask your lawyer.
So, REMEMBER your premiums will NOT go up or down based on anything you do regarding treatment, i.e, whether you have 0$ or $1,000,000 in therapy. This decision, by law, can only be made by the carrier based on whether the accident meets the State's guidelines of "at fault" or not. If so, then your rates go up with or without treatment. If not, no change either way.
Q: I was driving in New York and I was hit by someone also from New Jersey... what laws govern?
A: In this case, you have a choice of which State's laws you want to pursue your case under.
Q: Is there a deductible for auto insurance benefits?:
A: Yes, there is typically a $250.00 deductible which MUST by law be charged to you, BUT, we can agree to defer this payment until your settlement, if any.
Q.: Are there any other costs associated with Chiropractic/ Medical services rendered to an accident victim?
A: There may be....
a.-If your Attorney requests a narrative report, there is a fee for this and some lawyers lay this out for you, others will bill you at that time. Ask the lawyer.
b.-Also, if we are asked to come to Court to testify on your behalf, we will charge a per/hour fee for the time away from the office. This too, can be laid out by the Attorney, or billed to you when your trial comes up. Ask your lawyer before you sign them up to represent you.
c.- There are some cases where the patient (you) may need to continue treatment for a chronic condition, after the insurance carrier decides that they will no longer pay for the services.(And we will tell you if this happens) In this case, you will have certain choices:
i.- You can pay each visit out-of-pocket; or,
ii.- We can now legally bill your major medical carrier telling them it's an accident related injury and providing a copy of the denial from your accident insurance company....(but they may have to be paid back, if and when your lawyer sues your carrier (in a separate suit called a "PIP suit") to recoup these costs; or,
iii.- We can wait until you receive a settlement from your carrier, IF you have signed, and had your Attorney execute a valid lien against that settlement.
Q: Suppose there was no other vehicle involved in my accident, or the other vehicle ran from the scene, do I still have medical benefits under my auto policy?
A.: If you are insured in New Jersey, you still have medical benefits, and using them has nothing to do with any change in your premiums after the accident.
Q: I have a family friend who is a lawyer... does it matter who represents me in this matter?
A: Very much so! Lawyers are just like human beings (joke), who like you and I come with their own prejudices and preconceptions. Some are more intelligent than others and have themselves used Chiropractic services, and know and respect Doctors of Chiropractic (DC's). Others have no knowledge of Chiropractic, and if they, themselves have little respect for a DC, then how can they build your case on Chiropractic testimony? This would be like having a public defender represent you in a criminal case, whom you know really thinks you are guilty! Ask your Doctor to recommend an Attorney who is experienced in handling Chiropractic cases. Cases based on Chiropractic testimony have yielded some of the largest Court awards for similar injuries.... it's all in your lawyer's hands. Be sure. If your lawyer has never asked your DC for a report, and has given you a list of "real" doctors to see without discussing this with the DC managing your case, you probably have a lawyer with a preconceived and limiting view of Chiropractors. Ask your Doctor for a recommendation for a lawyer who will take over your case. You can almost always change lawyers.
REMEMBER, the fact that we OBEY the law, and will not participate in deceiving your carrier or anyone else, means that the Doctor's testimony is that much more valuable in Court.
PLEASE do not ask us to bill your major medical carrier if you were injured in a car accident, as we would have to sign a form stating that the injury was NOT due to a motor vehicle injury, and this would be INSURANCE FRAUD.
* nothing in this section should be construed as providng legal advice. If you have any question as to the validity or applicability of anything stated above, please check with a licensed Attorney.
*In the State of New Jersey, we have a very unfair law for workers known as a STRONG EMPLOYER, WEAK EMPLOYEE law. This means that for any on-the-job injury, your employer can determine which and what kind of doctors you may see. Since they have to have Worker's Compensation Insurance, the contract with the carrier normally assigns that right to the insurance carrier. HOWEVER, many companies do not know this, and may give you "permission to see your own doctor".
Remember, that since 1954 in Thomas v Carleton Hosiery Mills, the NJ Supreme Court ruled that Chiropractic Doctors are "Physicians". Thus, it is legal and moral to for you to ask ONLY for "permission to see your own physician". You probably should not specify what kind of doctor you plan to see, because despite that this law has existed since 1954, MANY people in human resources departments, and elsewhere still unfortunately do not know that a DC (Doctor of Chiropractic) is a "physician". You will need a note, signed by anyone in a position above you at work to have this binding upon them. Once you obtain such permission, we can treat you on assignment. And, the doctor is reimbursed 100% of billed services. There are NO deductibles or co-pays.
Q.: I was in a company car, and got into an accident. Is this an Auto Accident or a Worker's Comp case?
A: Both. You will need to speak to an Attorney to determine which carrier is liable for your bills.
Get [.PDF] permission form here
* nothing in this section should be construed as providng legal advice. If you have any question as to the validity or applicability of anything stated above, please check with a licensed Attorney.
We have made a decision to try to help you, please read this carefully to understand.
NO! YOU DO NOT NEED A REFERRAL Although we are NOT IN PLAN with ANY Company.
BUT... read on... seeing us may not cost you any more than an IN PLAN DOCTOR !!!
A Chiropractor is a Specialist Physician, NOT a referral service "providor". As of Jan 1, 2008, until posted further,
regardless of your HMO plan, (most discriminate against Doctors of Chiropractic and do not cover initial exams and other services anyway, and, they all require Doctors to do inordinate amounts of paperwork)
In lieu of having to file all their forms, i.e, for saving us that cost, and IF your plan has a co-payment of $30.00/visit or more for specialists, then if you just cover the fee for the initial exam, we will accept you for treatment for only your co-payment...... any questions? Thus, the only cost over an "in-Plan Doctor" for seeing Dr. Press, and receiveing the personal attention for which he is famous, is the initial exam...Call for a free initial consultation.
If you are over 65, and have regular MediCARE, then we will happily accept assignment of your benefits. If you have a Medicare plan other than regular MediCARE, then we will need to check with your coverage to see if you have Chiropractic benefits.
If you are still working then whatever plan you have though work will still be your primary coverage, and we will coordinate with MediCARE. If you are retired, then MediCARE will coordinate your benifits automatically.
If you have MediCAID as well as MediCARE we will happily accept your case, and MediCARE will coordinate your benefits automatically.
With regular MediCARE, regardless of which DC you see, you are not covered for the initial examination, or for any needed xrays, (please see our policy regarding taking x-rays) regardless (as of Jan 1, 2008) of who takes them for Chiropractic purposes. And, you will have an annual deductible which we MUST attempt to collect by Federal law. For all otehr services we will wait for MediCARE to pay us.
Then we will need to determine which plan you have to know if we can accept an assignment of your insurance. Most GHI plans cover only 6 visits per YEAR, and then pay only $6-10/visit. They also carry a $250.00 deductible, which means that after your six visits, they will lower your deductible by $36-60.00 and send us ZERO. Thus this is more like some kind of scam than insurance, and we will have to negotiate a fee with you in lieu of filing claims whcih will not be paid.
Then we will need to determine which plan you have to know if we can accept an assignment of your insurance. Some 1199 plans cover only 6 visits per YEAR, and then pay only $6-10/visit. They also carry a $250.00 deductible, which means that after your six visits, they will lower your deductible by $36-60.00 and send us ZERO. Thus this is more like some kind of scam than insurance, and we will have to negotiate a fee with you in lieu of filing claims whcih will not be paid.
On the other hand, SOME plans do cover Chiropractic on a reasonable basis, and we will accept those plans.
Medicaid has been off again and on again. Even when they "pay" for Chiropractic, it has traditionally been in the neighborhood of $6.00/visit, and they require that we do paperwork which costs us around $12.00/visit in secretarial time to get paid. Thus we cannot accept MedicAID, but will accept MedicAID patients if you will pay SOMETHING out of pocket for our time. We will negotiate a fee you can afford.
If you have MediCAID as well as MediCARE we will happily accept your case, and MediCARE will coordinate your benefits automatically.
NOTE: MedicAID patients, unless you also have MediCare, will only be seen during certain limited hours, and will be expected to make the negotiated payment each visit.
We truly want to help anyone who needs our services. Naturally, we cannot treat everyone for free, as we also have to pay our bills. We have a sliding scale based on ability to pay, within the confines of the State and Federal laws, for those who are unable to afford insurance. Please inquire when you come in for the free consultation. We WILL work out something you can afford.
Q: What is a Deductible? : A deductible is a set amount of money, essentially a goal... which your TOTAL bills for the year-to-date have to equal BEFORE the carrier starts paying anything to reimburse you for your expenses. For example, if you have a $1,000.00 deductible, your premiums (the price of your coverage) will be lower, but you will have to pay the FIRST $1,000.00 each year for ALL your Doctors bills out of your own pocket, before anyone (you or the doctor) gets reimbursed.
Some plans have TWO kinds of deductibles.... one level for any one person/year, an another called a "Family Deductible", which is an aggregate for all family members combined. Thus, if you have a family deductible of say, $2000.00 and you spent that on your care alone in any given year, then your spouse will have NO deductible on his/her care, if and when s/he come to be treated.
Q: What is a Copayment? : This is an amount that you MUST be charged by your doctor, OUT-of-POCKET for EACH visit. It's something like a per-office-visit deductible, and that seems to be what confuses people. All Policies have BOTH for out-of-network benefits. Again, the smaller the out-of-pocket part for YOU, the more money for them.... in other words, it's not whether you will pay out-of-pocket, it's only WHEN, and to whom you pay out-of-pocket... to the carrier for premiums, or to the doctor when you need his/her services.