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Sign away! You live in Texas - what's the worst they can do?
Sign. Go until your deductible restarts and then go somewhere else.
Don't go unless they remove the offending clause.
Tell them to get stuffed.
Your Statute of Limitations Waiver is in my pants!

Click here to see results so far.

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One point I can think of, not being a legal expert, is there's only so much liability they can waive. You can't sign make someone sign something that says "you can't sue if I maliciously take a mallet wack you on the head repeatedly and send you to the hospital", then do it, and get away with it (criminally or civil-wise).

Methinks that clause is a cover-all that probably can't really be enforced, although of course they can try. I'd perhaps get an opinion from a lawyer, or just find another doctor (or perhaps not a chiropractor at all and stick to actual medical professionals, but that's just me ;) ).
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The bottom line, Joel, is whether the service they provide is worth it to you to incur the risk that their waiver invites. Can you go to an alternate therapist that provides the same service without the waiver?

Fuskie
Who figures that 99% of their patients are not Fools and do not read the actual contract...
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I think the real question here is...


Where the heck have you been and how are YA?

:D

bleplatt
happy to see Joel back
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Joel

I live in Texas also. Several years ago a company that we had already done some work for, pulled out a contract after the fact and said that if we didn't sign it they wouldn't pay us. I spoke to an attorney and he said to take a black felt tip marker and cross out anything in the contract we didn't agree with, then sign it. When I got through with it there were about 3 lines on a several pages contract that you could still read. LOL

You also need to initital where you black out the writing.

Stockbuyer2
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The fact that they do this:

Consider this: Chiropractors routinely cap their bills. They will send your insurance a bill for as much as they think they'll pay. If the amount the insurance does not pay exceeds a fixed amount per visit, they'll often write off the difference in order to keep you coming back.

is actually insurance fraud. I don't know whether the insurance company would be able to recover the other money, or for how long, but you'd be signing a waiver for your participation in a criminal act. It might be good for the pocketbook initially but I hear handcuffs are pretty uncomfortable if you have back problems. ;-)

But consider that they're actually committing fraud against the company in *two* ways, not just one:

- A practice cannot submit to insurance a bill for more than the cash price they charge. This is why it always looks so horrible to see the prices if you're uninsured -- because absolutely no insurer will pay more than those prices, so doctors want to set them at least as high as the best-paying insurer will compensate them. The chiropractor's crediting your overpayment to your portion of future bills looks unethical when you realize that effectively, you're *earning* money to see the chiropractor.

- Once the bill is submitted through insurance, it is insurance fraud if you do not charge the patient the amount the insurance company says is the patient's part. (This is usually part of the language of the insurance providers' agreements with the practices.) If they want to write off a bill, they have to write off the *whole* bill, not just what insurance doesn't pay.

This just smells *way* too fishy for me.

-- Laura
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I think the real question here is...


Where the heck have you been and how are YA?

:D

bleplatt
happy to see Joel back


Sorry, bleplatt - it's my fault. I've been keeping Joel busy on the weekends and he hasn't had time to read the boards, much less post. ;)

aj
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Skimming Texas statutes I find a couple references saying that a statute of limitations may be shortened by contractual agreement, but not lengthened by contractual agreement.

I don't know if that applies only to those specific instances, which were not in regards to debt collection specifically, or if they can be construed to apply across the board. The statutes of limitations specifically mentioned with regard to debt collection does not have any similar language at all.

I would THINK you could sign that agreement and that clause would not be enforcable, but I'm no attorney. Don't go signing it based off of my opinion only.

xtn
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Sorry, bleplatt - it's my fault. I've been keeping Joel busy on the weekends and he hasn't had time to read the boards, much less post. ;)


oh! goodness!

:D

b
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To sign that I'd have to be hurting very badly and really believe this particular practitioner could help.
There are lots of doctors and lots of chiropractors out there. I'd tell the office manager that clause is offensive. To black it out is good; to work with somebody who doesn't commit insurance fraud and also doesn't make you sign something that says you'll give up your rights is worse.
I wouldn't tell 'em to get lost until I knew I had another place to go that would be at least as helpful for my problem.
Best wishes, Chris
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- Once the bill is submitted through insurance, it is insurance fraud if you do not charge the patient the amount the insurance company says is the patient's part. (This is usually part of the language of the insurance providers' agreements with the practices.) If they want to write off a bill, they have to write off the *whole* bill, not just what insurance doesn't pay.

Coming from a medical family, I'm not sure this completey reflects reality. Sure, the patient has to be charged their agreed amount, co-pay or whatever, but let's say you have a $20 co-pay on a $200 service. A bill for $180 gets sent to the insurance company. They pay whatever they feel like based on their own rate tables and the doctor is left with the excess. That's how it works. The patient is paying their agreed part, the insurance pays what they feel like, and the doctor is stuck with not getting the rest.

And if the doctor increases their rates on some procedure, it can be years until the insurance company compensates any more. It's not that the patient isn't paying their agreed part, it's that the insurance company isn't paying the rest of it, because they never agreed to anything with the doctor... and there's really about nothing a doctor can do about it. Yeah, they swallow the change instead of charging it to the patient to maintain good relations.

Another reason the doctor's 'rates' are so high, because they rarely collect more than some of it.
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DeltaOne81,

You wrote, Methinks that clause is a cover-all that probably can't really be enforced, although of course they can try. I'd perhaps get an opinion from a lawyer, or just find another doctor (or perhaps not a chiropractor at all and stick to actual medical professionals, but that's just me ;) ).

Yes, I don't think the clause is enforcable either. But I'm leaning toward not going unless they remove it from the contract as a matter of principal.

I actually had an appointment this morning that I cancelled because I had read this contract last night and couldn't bring myself to sign. Instead of going to the appointment, I called and cancelled and wrote this post on TMF instead.

So... Are physical therapists not actual medical professionals? (Any good chiropractor knows he's little more than a variant on a physical therapist. They're both therapist; but the chiropractor focuses on the skeletal structure over the muscular, while the physical therapist tends to do the opposite.) Government studies have shown that physical therapies and chiropractic adjustments offer superior pain relief for mild to moderately intense low-back pain and sciatica, when compared to traditional treatments approved by the AMA and offered by most medical doctors. Those treatments usually involve medications, such as pain killers, muscle relaxers (anti-spasmodics), anti-inflamatories and steriods.

Background

I've already tried all of those treatments and they all have side effects that are often as bad or worse than the problem they're treating. They're certainly problematic when you're talking about treating a chronic problem such as a ruptured disc.

My choice of treatment has been Celebrex (200mg 2x/day) and chiropractic therapy. However, it's been increasingly necessary to supplement my Celebrex with naproxin. My physician won't up my Celebrex dosage and the stomach problems caused by prolonged use of naproxin are almost as bad as the pain it relieves. From my experience steriods help and have few negative short-term side effects; but she won't prescribe any more of those either.

At this point, she's offering a maintance prescription of a muscle relaxer (treats one of the symptoms) and she's referred me to this chiropractor that also offers physical therapy. The only remaining alternatives are: 1) seek a new physician; 2) spinal fusion (remove the disc and fuse the vertebra); or 3) replace the disc with an artifical one. The later option has only recently been approved for use in the States, so there's not a lot of long-term emperical data on this treatment option.

- Joel
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And along with my lone Lone Star<*> Vote, let me say:
"Yee Hah!!!!!!"


joycets
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PosNetWorth,

You wrote, The fact that they do this ... is actually insurance fraud.

I said I wasn't really interested in debating the ethics of this ...

And this really has nothing to do with the question I was asking. I was only observing that this is a pretty standard practice with chiropractors and it quickly illustrates why signing the contract in question could come back to haunt me. Roofing contracts actually do something similar and I know for a fact that the insurance companies know about it, but take no issue with it. Perhaps insurance fraud really is as rampant as the insurers say. Too bad they don't do more to stop it, eh?

Well, I'm not going to loose any sleep over it anyway. The practice isn't mine. The small difference in price wouldn't affect my decisions all that much - I'm not really that poor - and I do nothing to encourage them to write any of it off like that. Perhaps the insurance companies should do a better job negotiating for lower rates instead of spending their efforts trying to get the physician to fill out reams of paperwork to justify their existence?

The services stated in the bills to the insurance company were accurate and correct. Those services were rendered as stated. The insurance company paid the chiropractor at the contracted rate. I paid the chiropractor what he asked for ... as long as it's no more than what the insurance company says I owe. That's all I'm interested in.

All that aside, it has nothing to do with the question at hand. This was just one of many possible examples of how the chiropractor could come back and try to sue me for an "unpaid" bill 10 years after the fact. Even if you could waive a magic wand and make this type of "fraud" go away, I could come up with other examples. This just seemed like an obvious example, so I cited it.

- Joel
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xtn,

You wrote, Skimming Texas statutes I find a couple references saying that a statute of limitations may be shortened by contractual agreement, but not lengthened by contractual agreement.

Citations (links), please?!

- Joel
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Crosefield,

You wrote, To sign that I'd have to be hurting very badly and really believe this particular practitioner could help.
There are lots of doctors and lots of chiropractors out there. I'd tell the office manager that clause is offensive. To black it out is good; to work with somebody who doesn't commit insurance fraud and also doesn't make you sign something that says you'll give up your rights is worse.
I wouldn't tell 'em to get lost until I knew I had another place to go that would be at least as helpful for my problem.


Right you are. I've pretty much reached the same conclusion.

- Joel
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Greetings, Joel, what has been said about the possibility of a Pain Clinic referral for an epidural steroid injection? That's a bridge treatment between oral pain meds plus manipulation techniques such as PT or chiropractic and submitting to surgery. Sometimes the pain relief from the epidural steroid is sufficient to last long enough to make the lower level treatments even more effective, avoiding a surgery. And if it comes to having to have a surgery, there are sometimes microdiskectomy techniques which are a whole lot less invasive than a fusion. What's been the result of investigating these options?

Also, have you been put on a proton pump inhibitor medication (Prilosec is over the counter) which may help ease the dyspepsia caused by Celebrex/Naproxen - just another thought.

xraymd
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bleplatt,

You wrote, I think the real question here is...


Where the heck have you been and how are YA?


I've been spending all my weekends with aj485! That and we spend an hour each night on the phone during the week. Also, my employer started monitoring internet traffic, so I've not been doing any reading or posting on TMF during my free time at work.

I still occasionally read threads on the boards - mostly when aj485 tells me about them - but I can't seem to keep up with you guys any more. Posting has been pretty much out of the question, especially if my answer is involved.

- Joel
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aj485,

You wrote, Sorry, bleplatt - it's my fault. I've been keeping Joel busy on the weekends and he hasn't had time to read the boards, much less post. ;)

To which bleplatt replied, oh! goodness!

Yes... That was a very Good Friday... ;-)

- Joel
As has been every Friday since! And Saturday ... and Sunday too! >:)
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xraymd,

You wrote, Greetings, Joel, what has been said about the possibility of a Pain Clinic referral for an epidural steroid injection? That's a bridge treatment between oral pain meds plus manipulation techniques such as PT or chiropractic and submitting to surgery. Sometimes the pain relief from the epidural steroid is sufficient to last long enough to make the lower level treatments even more effective, avoiding a surgery. And if it comes to having to have a surgery, there are sometimes microdiskectomy techniques which are a whole lot less invasive than a fusion. What's been the result of investigating these options?

Been there, done that two years gone. Spinal steriod injections offered only moderate, temporary relief. The results were only slightly better than oral steriods. Bear in mind that I'm going on 3+ years since the disc ruptured. I'm told that steriods tend to have diminishing returns the older an injury gets.

I've not investigated microdiskectomy. I assume it's some kind of removal or reconstructive procedure?

FWIW, the left side of my L3:L4 has ruptured and the disc has almost completely collapsed. My problems of course are a direct result of L3 and L4 pinching off the sciatic nerve bundles. The initial symptom was intense pain and almost total paralysis in my left hip and leg. Today, I have a managable loss of feeling in my left leg and hip as well as a small loss of motor control (coordination). Unfortunately, muscle spasms and low-level pain on both left and right hips, legs and low back remain a chronic problem even with all the medication.

You also wrote, Also, have you been put on a proton pump inhibitor medication (Prilosec is over the counter) which may help ease the dyspepsia caused by Celebrex/Naproxen - just another thought.

Prilosec has the opposite effect on me. It gives me heartburn and my BMs are bright yellow and it makes my rectum burn. Except for old-fashioned calcium-based antacids, there are no over the counter antacids that are effective on me. Instead I take 20mgs of aciphex twice a day. (Normal dose is 1/day ... and my insurance company thinks I'm try to defraud them with this one.) That dose barely does the job most days. Other days it isn't enough.

I never used to have serious heartburn. It all began after my doctor put me on prescription strength naproxin about 6 weeks after my disc ruptured. I went through several jumbo boxes of Sam's Club's version of Tums, followed by every over the counter antacid I could find. Those just made my condition worse. My doctor even gave me a couple different prescriptions before switching me from Naproxin to Celebrex.

Unfortunately I've not been able to stay off the naproxin because the Celebrex doesn't seem to be as effective as it once was. So now I take aciphex twice a day...

- Joel
Who thinks aj485 is secretly appalled by all the pills I take these days...
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Joel
Who thinks aj485 is secretly appalled by all the pills I take these days...


maybe aj485 is secretly jealous! ;)

jmc
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Greetings, Joel, so sorry for your travails. Have you tried Cytotec to help replenish the protective stomach lining that Naproxen erodes? Aciphex clearly can work where Prilosec fails (this is another in the family of proton pump inhibitors, or PPIs) and there are many others in this family which may or may not work better than Aciphex.

Obviously the best solution would be if you could get off the anti-inflammatories altogether. Microdiskectomy procedures are becoming much more frequently done here in Tucson but of course whether you are a candidate depends on the extent of the injury. It is a very targeted surgery with a keyhole incision and those who receive it (if they qualify) are generally discharged home fully ambulatory the next day. Perhaps it would be a worthy investigation? Also, what about pool therapy and a TENS unit as further alternatives to meds? Even acupuncture could have a possible role, as could Neurontin as an alternative to so much Naproxen. Just emptying the wastebasket of what I currently know about disk herniations/ruptures.

xraymd
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Coming from a medical family, I'm not sure this completey reflects reality. Sure, the patient has to be charged their agreed amount, co-pay or whatever, but let's say you have a $20 co-pay on a $200 service. A bill for $180 gets sent to the insurance company. They pay whatever they feel like based on their own rate tables and the doctor is left with the excess. That's how it works. The patient is paying their agreed part, the insurance pays what they feel like, and the doctor is stuck with not getting the rest.

DeltaOne --

I think you're partially right on the money here. If the doctor has contracted with an insurance company, they have to accept the negotiated rates, even though they are less than the billed amount on paper. When I go to an out-of-network physician -- one that hasn't made any price agreements with insurance -- I have to pay the portion that my insurance company doesn't pay, both my 20% copayment and whatever the insurance company says is above "reasonable and customary charges." Reasonable and customary my @ss!!!

The same thing holds true with doctors who agree to accept Medicare patients. They must "accept assignment" -- that is, take what Medicare says is the price for the procedure and not bill the patient for anything above those charges. That's why fewer and fewer people are accepting these patients. (I'm on a hospital advisory board up here, and they say here they're compensated for Medicare for less than 90% of the actual physical cost to the hospital, and state Medicaid reimburses less than two-thirds of the cost.)

Doctors definitely don't hold the power in the relationship, though. All of the cardiologists near us are in one group, together. One major insurance company just refused to do business with them because the cardiologists wouldn't agree to less-than-cost reimbursements. Now you have to drive an hour or more for in-network coverage. (The rule is that you have to have a network physician within an hour of you or the insurance has to reimburse a non-network one for the same rate, I think -- that seems to be what the newspaper reported.)

-- Laura
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Joel,

I wrote wrote, The fact that they do this ... is actually insurance fraud.

And you said, I said I wasn't really interested in debating the ethics of this ...

I know that you said you aren't debating the ethics of this. It sounded like you were uncomfortable with it anyway, so I just wanted to let you know. The reality is this, though: you should know is that it possible (in some far-off reality) have some legal repercussions, although that is extremely unlikely. And the insurance company would be far more likely to put the chiropractor out of business than to demand any difference in payment from you.

Some of my providers used to TWIP me -- take what insurance pays -- but none of them do any more. I assume that means that they've cracked down on it some here.

-- Laura
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A direct link doesn't work because of the way their website is set up to serve the documents, but here is the homepage:

http://www.capitol.state.tx.us/cgi-bin/cqcgi

You'll need to look on the left side of the page under RESEARCH and click STATUTES.

Civil Practives and Remedies Code
Chapter 16. Limitations

Scroll down to § 16.004. It specifically establishes a four year limitation on debts.

Scroll down to § 16.070. It says any contract establishing a limitation of less than two years is void. It does not address a situation wherein a contract tries to establish a limit longer than that established by statute. I don't know how to interpret the lack of any such language.

Here is one that DOES have such language, but I would think it only applies to the specific condition being addressed, which in this case is Contracts for Sale:

Business and Commerce Code
Chapter 2. Sales
Scroll down to: § 2.725. (b)

I can't definitively answer you questions based on these statutes, but at least if you do decide to consult an attorney you might save some time by having these references handy. My gut tells me they should not legally be allowed to indefinitely extend the limitation period that is established by code. Even if they can extend it, I would imagine the 'indefinitely' nature would probably get it tossed.

xtn

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Crap, that cgi-bin stuff doesn't work either. Here is the proper homepage link:

http://www.capitol.state.tx.us/

xtn
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Joel said:
Who thinks aj485 is secretly appalled by all the pills I take these days...

then jmc said:
maybe aj485 is secretly jealous! ;)


Actually, I'm closer to being appalled than jealous, lol - I certainly wish that my YOUNGER boyfriend didn't have to take so many pills than his OLDER girlfriend!

aj
- who does think Joel was up too late last night and that he will be very tired when we talk tonight


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To which bleplatt replied, oh! goodness!

Yes... That was a very Good Friday... ;-)

- Joel
As has been every Friday since! And Saturday ... and Sunday too! >:)


OH MY!

bleplatt
very happy for you two!
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Tell 'em to get stuffed. Ask your physician to recommend another PT/Chiropractor, or ask your friends for recommendations. There must be more than one place you can go to get this treatment. So tell them why you're taking your business elsewhere, and take it elsewhere. Or, if you really like them, see if you can get them to agree to take that clause out of your contract. If they won't, tell 'em bye bye.

Just my two cents, and also, good to see you again! Where you been, hoss?


--Booa
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I've been spending all my weekends with aj485! That and we spend an hour each night on the phone during the week. Also, my employer started monitoring internet traffic, so I've not been doing any reading or posting on TMF during my free time at work.

I still occasionally read threads on the boards - mostly when aj485 tells me about them - but I can't seem to keep up with you guys any more. Posting has been pretty much out of the question, especially if my answer is involved.

- Joel


Well, good for you! I've missed you, but I'm glad you and aj845 are still going strong. It would be good to have an update on just The Life Of Joel, when you have a minute...


--Booa (Not just the President of the Joel Corley fan club, I'm also a client! Wait, that came out wrong...;-))
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<<Statute of Limitations: Patient(s) waive the right to claim any Statute of Limitations regarding claims for services rendered or to be rendered by the physician/facility named above, in addition to reasonable costs of collection, including attorney fees and court costs if incurred.
>>


It's very common to include provisions in contracts that obligate the debtor to pay the costs of collection. If I had someone who refused to sign such a provision in a contract, I'd tell them to take a hike.

As far as the waiver of the Statute of Limitations --- I haven't heard of that one before. As suggested earlier, it might be unenforceable.

But I'd assume it to be enforceable unless I had authoritative information to the contrary.

If you don't like a provision in a contract that is offered to you, you can always cross it out. That leaves it up to the other party to either accept your amendment to the contract or refuse to accept it and tell you to go elsewhere.

If I were dealing with you, I'd accept your crossing out the Statue of Limitations waiver, but require you to agree to pay for the costs of collection if you wanted me to work for you.

That's fair, in my opinion.



Seattle Pioneer
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Fools,

For what it's worth, the doctor struck this clause from their contract before I signed it ... and I've seen him three times already.

As for my back problems, the x-rays showed normal joint spacing in the damaged disc - contrary to post-injury x-rays and MRIs. The doctor/therapist feels that the joint has healed properly - with associated scaring - but that I've lost "core" muscle strength, which is causing me to slouch, which is in turn causing joint and nerve irritation resulting in muscle spasms. His solution is strength training for core back muscles as well as anterior and posterior obliques.

My strategy is to go a few times until I'm confident I'm performing these exercises correctly, then quit. If necessary, I'll return to my old chiropractor for an occasional back adjustment. Hopefully this strategy will reduce some of muscle spasms and low back pain I've been suffering from, which should also reduce my dependence on anti-inflammatories and prescription antacids...

- Joel
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