Guest guest Posted June 23, 2004 Report Share Posted June 23, 2004 Dear Dr. Burke: IME doctors have taken quite a bit of criticism in this listserve. I think as you say " every one of our clinical impressions and treatment decisions is subject to outside review " is always true when a third party insurer is involved. No surprise here. It seems that everyone has a case that went to am IME and had it cut off because of some technicality or another that obviously went in favor of the insurer. I haven't seen someone write in and brag about how they milked an insurer for extra treatments. Opinions, even professional opinions, are always varied. My belief has been that an indemnity insurer will stop paying voluntarily for care after about 3 months. They may pay longer, but it will take considerable documentation and extensive examinations to make the case; and, unfortunately, meanwhile no payments are getting made. At this point the patient had better have an attorney with a winning record and the doctor hade better be comfortable to wait until the courts are finished (2 years). In 2 decades of practice I have seen very few losses within those parameters, but I still remember them clearly. I might blame the IME but so what? I like the new requirements Dr. Saboe has proposed that require IME's to evaluate all documentation to determine medical necessity. I don't think that it will change the outcome. The only way to change the outcome is for passage of a law that requires an indemnity insurer to decide to pay for a service within 30 days of receipt of billing. This would let the patient know what we already know: any injury that takes longer than 3 months to heal will be litigated. Even if the car cost $10,000 to repair, the insurer will squabble over $50 for the repair of injury after 3 months of care. Sincerely, Willard Bertrand, D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2004 Report Share Posted June 24, 2004 Dear Dr. Bertrand I would like to start on by saying that in the past I have done independent examinations occasionally. I have not done examinations requested by insurance companies for the past two years. I do however when requested performed consultation examinations requested by the treating chiropractor. These examinations are usually requested for one of two reasons. The doctors may be frustrated with the patient's progress or the insurance company is threatening to cut off care and the doctor does not believe discontinuation of care is warranted. The doctor is provided with a detailed report of the examination along with findings and recommendations for future care. This report can be forwarded to the insurance companies. The environment for this examination is nonconfrontational and I have found that the patients are truly impressed with their chiropractor for his/her additional effort in doing everything he/she can for the benefit of the patient. I have at times referred out the patients of mine for similar consultation examinations. Sometimes an outside view can provide important information to benefit in the care of the patient. What if we as chiropractor's would do this routinely to support the care are patients deserve? Rodney Cross DC RE: Re: IME gripes > > Dear Dr. Burke: > > IME doctors have taken quite a bit of criticism in this listserve. I > think as you say " every one of our clinical impressions and treatment > decisions is subject to outside review " is always true when a third > party insurer is involved. No surprise here. > > It seems that everyone has a case that went to am IME and had it cut off > because of some technicality or another that obviously went in favor of > the insurer. I haven't seen someone write in and brag about how they > milked an insurer for extra treatments. > > Opinions, even professional opinions, are always varied. My belief has > been that an indemnity insurer will stop paying voluntarily for care > after about 3 months. They may pay longer, but it will take considerable > documentation and extensive examinations to make the case; and, > unfortunately, meanwhile no payments are getting made. At this point the > patient had better have an attorney with a winning record and the doctor > hade better be comfortable to wait until the courts are finished (2 > years). In 2 decades of practice I have seen very few losses within > those parameters, but I still remember them clearly. I might blame the > IME but so what? > > I like the new requirements Dr. Saboe has proposed that require IME's to > evaluate all documentation to determine medical necessity. I don't think > that it will change the outcome. The only way to change the outcome is > for passage of a law that requires an indemnity insurer to decide to pay > for a service within 30 days of receipt of billing. This would let the > patient know what we already know: any injury that takes longer than 3 > months to heal will be litigated. Even if the car cost $10,000 to > repair, the insurer will squabble over $50 for the repair of injury > after 3 months of care. > > Sincerely, > > Willard Bertrand, D.C. > > > > > > > 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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2004 Report Share Posted June 25, 2004 Hi Dr. Cross: You asked: " Sometimes an outside view can provide important information to benefit in the care of the patient. What if we as chiropractor's would do this routinely to support the care are patients deserve? " Yes, it sounds like a plan to avoid excessive treatment complaints and educate the patient. One problem: who will pay for it? It seems that the cash patient has a dollar figure attached to their treatment plan. Let's say that every cash patient is willing to spend $1500. Now you can get all of that or you can share it with others. If you make arrangements to pay for the evaluation yourself, then there is a sense of collusion between two doctors to make the patient believe that the exams and treatments are necessary. That is one big reason why chiropractors generally refer outside of the profession or to specialists within the profession. It helps to refer to a surgeon since you will be the good guy who prevents the surgeon, same goes for the medic and the usual drug approach. Easy referrals, often good documentation of the problem, but almost never a recommendation for chiropractic care. Either way the patient will lose a chunk of the fee to an examination when it could have went to treatment. For insurance companies it is basically the same, but we need more paperwork and so we refer to the medics when we are sure they will recommend surgery or drugs and then take the credit when the patient gets well with chiropractic thus avoiding the expense of surgery or the useless drug approaches. Willard Bertrand, D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2004 Report Share Posted June 25, 2004 Hello Willard This approach can and occasionally is be done with cash patients, however the majority of the time it's either motor vehicle accident or workman's compensation injury's. In my experience . The documentation and support from fellow chiropractors willing to provide this service have been excellent and have helped support further care when necessary. Thanks for your reply . Rodney RE: Re: IME gripes > Hi Dr. Cross: > > You asked: " Sometimes an outside view can provide important information > to benefit in the care of the patient. What if we as chiropractor's > would do this routinely to support the care are patients deserve? " > > Yes, it sounds like a plan to avoid excessive treatment complaints and > educate the patient. One problem: who will pay for it? > > It seems that the cash patient has a dollar figure attached to their > treatment plan. Let's say that every cash patient is willing to spend > $1500. Now you can get all of that or you can share it with others. If > you make arrangements to pay for the evaluation yourself, then there is > a sense of collusion between two doctors to make the patient believe > that the exams and treatments are necessary. That is one big reason why > chiropractors generally refer outside of the profession or to > specialists within the profession. It helps to refer to a surgeon since > you will be the good guy who prevents the surgeon, same goes for the > medic and the usual drug approach. Easy referrals, often good > documentation of the problem, but almost never a recommendation for > chiropractic care. Either way the patient will lose a chunk of the fee > to an examination when it could have went to treatment. > > For insurance companies it is basically the same, but we need more > paperwork and so we refer to the medics when we are sure they will > recommend surgery or drugs and then take the credit when the patient > gets well with chiropractic thus avoiding the expense of surgery or the > useless drug approaches. > > Willard Bertrand, D.C. > > > > > > > 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. > Quote Link to comment Share on other sites More sharing options...
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