In personal injury cases, chiropractors play a vital role in a patient’s recovery, but did you know that insurance companies are constantly looking for ways to reduce or deny claims? One of the most common tactics they use is attacking gaps in treatment. Understanding this strategy can help you protect both your patients and your practice.
What Insurance Companies Look For
Insurance adjusters are trained to scrutinize treatment records. They often look for:
- Missed appointments or inconsistencies in scheduling
- Large gaps between treatment sessions without a documented explanation
- Lack of detailed progress notes
- Minimal or generic descriptions of treatment provided
Any perceived lapse can be interpreted as a lack of necessity or diminished injury severity, giving insurers leverage to lower payouts or deny liens.
Why This Matters for Chiropractors
Gaps in treatment don’t always indicate patient non-compliance they can happen for legitimate reasons, like transportation issues, scheduling conflicts, or insurance approvals. However, if these gaps aren’t properly documented and explained, insurance companies may argue that the patient’s care was not medically necessary or that the injury is less severe than claimed. This can negatively impact both the patient’s recovery and your ability to receive fair reimbursement.
How Chiropractors Can Protect Against Insurance Challenges
- Document Everything: Record all appointments, including cancellations or rescheduled sessions, and note the reason for any gaps in treatment.
- Progress Notes Matter: Include detailed observations, changes in symptoms, and adjustments made to treatment plans.
- Communicate with Patients: Make sure patients understand the importance of attending sessions consistently and reporting any changes in symptoms.
- Coordinate with Attorneys: When patients are pursuing injury claims, provide timely and thorough records to legal teams so they can defend the treatment plan and protect provider liens.
Gaps in treatment are a normal part of patient care, but they can become a tool for insurance companies if not properly documented. By keeping detailed records, maintaining open communication with patients, and coordinating with attorneys when necessary, chiropractors can ensure their care is respected, their patients get the full recovery they deserve, and their practices are protected from unfair claim reductions.
