SAIF vs Liberty NW

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Listserv,

After all the discussion on the serv lately advising to avoid SAIF, one of my secretaries mentioned something I'd forgotten. This is not necessarily an endorsement for SAIF, just mention of some things that happened at my office.

1. Liberty NW was the first WC carrier to deny all payment on a claim of mine where there was not double signatures on the 'treatment plan'. You know how we're required to get a referral from an MD with certain parameters included in the referral? I've always done that. The Rx includes treatment, frequency and duration signed by the MD referring. I have billing send a copy with the bills. SAIF always pays on that info. However, there's small print saying that the DC must also sign the referral and send a copy back to the MD or the insurer can deny ALL payment. This must be done within 7 days of the referral or it can be denied! SAIF has never, I repeat NEVER followed that letter of the law in my office. I wasn't aware of the law until that happened.

2. Liberty uses/used silent PPOs. I battled with them for over 2 years after they 'bought' a contract I had signed with 'chirocare', (not chironet - they don't participate in silent sales). I was never informed that the contract was sold to auto carriers, work comp carriers etc. In fact, I'd opted out of the contract 1 year prior to it being bought. However, my 'contract' was included in the sale somehow...without my knowledge. I lost lots of $ over 2 years trying to get them to stop nickle and dime reductions. Every LIberty auto claim that came in over 2 years was reduced dramatically. They said I had to notify them in writing that I wanted the contract nullified. Then I had to continue to honor it for 6 months after that date! I could've won in court, but obviously LIberty had more $ than me and it would've depleted my resources to take them to court.

3. SAIF recently (2 months ago) extended a claim without MD referral, simply on a letter I wrote asking for 2-3 more appts to finish up active exercise with a patient. The patient's claim rep called and spoke with mysecretary and simply OKed the office visits prior to scheduling!

There's my 2 cents worth.

Minga Guerrrero DC