Q:
Good morning Dr. Margolies,
I had an incident that really took the wind out of my sails, and would like your opinion.
I have been seeing a patient for some time now.  I consider her a very good pateint.  She 
works for the school district and has State Merit insurance.  When she comes in, she 
WANTS to be put on Elect. Stim. before I adjust her because it appears to help with the 
adjustment, and besides, she likes it.
I bill insurance $30.00 for the adjustment and $25.00 for the therapy.for a grand total of 
$55.00 for the office visit. I get re-imbursed 90% for the visit so I don't charge her the co-
pay.
Well she came in this week and basically called me a crook for billing such a hiigh fee.  She 
then went on tell me that her last chiropractor ALWAYS did therapies but NEVER billed 
the insurance  for them.  She claims he ONLY billed for a $25.00 office visit.  My 
response was "well, he does things his way, and I do things my way."  (Incidentally, a 
new chiro. just opened up down the street charging only $10.00 for 
adjustments) which I feel is part of the problem these days!
I don't think charging for the services I render is wrong like this patient is trying to make 
me feel.
How should I handle her when she comes back, and do you think my fees are too high?



A:

These things happen .. it won't be the first time either .. so don't take it personal or get 
overly upset. Your fees are in order and there is nothing to feel uncomfortable about. My 
response .. especially if a patient has been to another DC is simple .. "I base my fees on 
what is considered usual and customary within theyour area. The fees for adjustment and 
adjunctive therapy as well as exams and x-rays are usually considered seperatly and this is 
why the insiurance company considered it .. as it is within the realm of usual and 
customary. Your previous DC decided not to file for this component .. that was his 
decision .. I have bills as you do and I wish to practice within the bounds of ethics .. 
therefore I maintain usual and customary fees and file accordingly." 

If the patient feels you bill cash patient sone way and insurance another .. as many DC's do 
.. then they may have reason to gripe .. but I would let this one ride out and go with the 
flow

Have a Great Day

Dr. M