Re: Fw: Personal injury question again

[Guest guest]

Doctors:

I agree with Dr. Freeman in many regards on this issue, and wanted to

raise an issue that has been briefly mentioned in passing.

Presently, the only providers with the legal right in Oregon to file a

legally binding lien are the Hospitals, the M.D.s, the Acupuncturists

and the podiatrists. In other words, DCs, PTs, NDs, LMTs, DMDs and the

rest are not covered. I brought this up to a few legislators a few

years ago through ODOC, and legislative counsel investigated this and

thought that the law as it stands is rather odd. They informed us that

it had to be changed by legislation though, and so this might be a good

thing for ODOC and/or CAO to go after in the next legislative session.

It sure would be nice if you could protect your bill.

Apparently the intent of the lien statute was only to protect hospitals

but when the Acupuncturists and podiatrists fell under the medical

board licensing (ORS 677 I believe), they also got the privilege to

file a lien.

The problem you are discussing here arises because injured parties have

the right to instruct their lawyers not to pay certain bills. And, if

they do so, the lawyer is ethically obliged to not pay the bill. Very

few of my clients would ever think about doing such a thing, but once

in a while someone tries to screw over their doctor and I have to sit

down and have a discussion with them about the problem, and the

ramifications. I would suggest that I probably have one incident per

year in which I cannot pay a specific bill in full due to the client's

instruction, and of those most have involved a situation in which the

client claims that the visit(s) never took place. If that is the issue

I leave it up to the client and doctor to resolve.

For some time, I have told DCs during my seminars that this thing about

cutting your bills all the time is in large part due to problems within

our own profession. Part of it is that DCs allow lawyers or insurers

to do this. Often the DC has decided to work with a lawyer / lawyers

who don't want to dig in and do the dirty work of getting full value

for a case. So, instead they accept $3,000 total for a case where you

have $5,000 in bills, and so of course there is no way to get full

payment. If you deal with these lawyers a lot, then you are going to

keep getting requests to cut bills. Another problem is that claims are

being evaluated by computer systems in about 70% of the cases (i.e.

Colossus, etc.) and if you aren't taking appropriate chart notes, no

lawyer can get a sufficient settlement to cover your bills. In that

case, you really have no one but yourself to blame for the low

settlements leading to the request to cut your bill. If you have 50

treatments where the Subjective note is " Pt. Returns " , " Same " or

" Better " with no other information about how the patient is really

doing you can expect that you are going to get cut even if the client

had the best lawyer in the world. So, it is your responsibility to get

up to date on what needs to be in chart notes.

Another issue is insurance company payoffs on outstanding bills. I am

now seeing the " at fault " /3rd party insurers who will settle a case for

$x + PIP + Outstanding Bills, but then they come back and try to

negotiate with the providers with the outstanding bills, and the truth

is that they have agreed to pay them off. So, in other words, they

have agreed to pay them off, regardless of how that can be done. If

you are smart you tell them that you charge what the service is worth.

In other words, you don't charge extra believing that you are going to

have to take a reduction, and as such you want to be paid at 100%.

They essentially have to pay it because they have settled the case with

the agreement that they will pay the bill off. If they don't pay off

your bill, they can be sued by the patient for breach of contract. If

you aren't smart, you let them talk you into accepting 30%, or 50%, or

something else than what the service is really worth. Safeco has done

this in at least two cases recently that I can recall; they settle the

case and agree to pay back PIP and the providers, then try to cut the

PIP payoff and the providers. So, keep in mind which insurer is

calling (it won't be the PIP carrier unless both parties had the same

company), and they will be asking you to cut your bill. Just say no.

Another problem I am seeing is that HMOs/PPOs/managed care, has damaged

all provider's ability to receive full payment. This is because

insurers say " well Dr. X accepts $30/adjustment when he provides

services to company Y, so he should do the same for us. " They then ask

you to take the same reduction. Keep this in mind when you agree to

participate in such an organization, you can expect that you will be

asked to take similar reductions on outstanding PI bills. We have a

new managed care group entering Oregon in the next month or two and my

advice is to not join for this specific reason, and many others.

With all this said, Dr. Freeman is correct about large billings,

particularly in cases which are not factually strong enough to support

a trial outcome sufficient to cover the bills. My background suggests

that you will face greater than usual payment problems in cases with

vehicle damage under $1000. So, make sure the patient gets a good

estimate on the vehicle, not just an insurance company estimate.

The problems of a patient's legal case are not always clear to the

lawyer in the beginning of the case, after depositions, or even up

until they get hit with it at trial. I personally have been blindsided

in a trial with very nice clients who have mistakenly forgotten to tell

me things. Other times we as doctors don't really know how bad certain

facts may be on a case, and often problematic legal issues aren't even

raised in the doctors clinic. So, from time to time lawyers do find

themselves looking at a case where it is a better option for the client

to accept less money in a settlement than to push forward with a risky

trial that may cost more to pursue than the injured party could hope to

recover. In such cases, it would make sense to take a reduction

because it is better to get 70% of your bill, rather than 0%. I am a

firm believer that attorneys should take a reduction if they are asking

the providers to take a reduction, and that if one provider is asked to

take a reduction, all providers should be asked for the same thing. In

other words, lawyers shouldn't expect the chiropractors to take a

reduction when they aren't asking the MDs to take a reduction. That is

clearly a sign of disrespect for your credentials and your work. The

problem is that there are some attorneys who refuse to take a reduction

themselves in order to settle the case, and then essentially demand

that the chiropractor cut their bill. And, I have seen this destroy

long term relationships between providers and lawyers. But, if you

aren't ending relationships when the lawyer does this to you again and

again, you have to ask yourself why not? And, are these people really

looking out for the best outcome for your patients?

So, that is my perspective as both a DC and a lawyer and hope this

sheds some light on it for the many doctors concerned about this

problem.

DeShaw, D.C., J.D.

>  

> Personal injury question again

>

> Hi folks, just looking for some wisdom to guide me through a situation

> that i have not experienced in my young career. I have a 39yo male who

> was in an accident in July 2003. Rearended. He had a lapse of

> insurance coverage during the time of the accident and was NOT

> covered. However, he has retained an attorney and they are sueing the

> other driver for the vehicle damage and medical coverage.(case has not

> been settled as of yet He's still in pain and wants to seek treatment.

> I'm a bit skidish. Liens, patient out of pocket, health insurance,

> forget it about the case all together??????? Could some of you whom i

> know have much experience in this area please help with some guidance?

> thank you.

>  

> doc Joe Medlin

> PDX

>

>

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> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is

> to foster communication and collegiality. No personal attacks on

> listserve members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

> However, it is against the rules of the listserve to copy, print,

> forward, or otherwise distribute correspondence written by another

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>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is

> to foster communication and collegiality. No personal attacks on

> listserve members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

> However, it is against the rules of the listserve to copy, print,

> forward, or otherwise distribute correspondence written by another

> member without his or her consent, unless all personal identifiers

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>

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is

> to foster communication and collegiality. No personal attacks on

> listserve members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

> However, it is against the rules of the listserve to copy, print,

> forward, or otherwise distribute correspondence written by another

> member without his or her consent, unless all personal identifiers

> have been removed.

>

>

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is

> to foster communication and collegiality. No personal attacks on

> listserve members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

> However, it is against the rules of the listserve to copy, print,

> forward, or otherwise distribute correspondence written by another

> member without his or her consent, unless all personal identifiers

> have been removed.

>

>

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