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Today's post comes to us from Walt Schmittinger, offering up the outcome of a UR appeals case tried to the Board in Milford two weeks ago. The appeal was from a UR non-cert of chiropractic care with Dr. Michael Gandolfo. Here is what Walt had to say:
"Actually I found it noteworthy as a general matter only because the Board explicitly recognized the inadequacy of Dr. Kalamchi's credentials and professional experience when brought to bear as a DME doc on a chronic pain management, and particularly chiropractic pain management, issue..........Other than that, it's an extensive/multiple body part injury case that warranted substantially more than the 26 visit limit on chiro care under the Practice Guidelines for chronic pain, so we got what we were after in a reversal of the UR determination. "
So, the claimant prevailed and in the battle of the medical experts, spine surgeon Dr. Ali Kalamchi fell on his own sword.....or shall I say scalpel? This post is my Christmas gift to all the chiropractors out there. Carolyn Cohee v. State of Delaware, IAB# 1337745 (12/7/11), drafted by none other than [Hearing Officer] Angela "Quick Fire" Fowler for Board Members Barber and Dantzler.
So in reply to the riddle "When is a chiropractor superior to a surgeon?", read the attached and find out. And remember-it's all about the pain. As Aristotle said: "The aim of the wise is not to secure pleasure, but to avoid pain." Looks like this Board panel and Dr. Gandolfo agree.
Irreverently yours,Cassandra Roberts
Visit Delaware Detour & Frolic, a law blog by Cassandra Roberts
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