Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 24 G

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"MedPay Reimbursement Notice"

24 g

 

IF...you are in a MedPay state, the personal injury carriers are contracting with managed care companies for coverage of their insured under the MedPay provision. Although this is not new news, the carriers have found that many doctors are unwilling, out of fear, to leave the managed care umbrella. Therefore, the carriers, when writing new policies for their insureds, are adding language to include partnerships under the MedPay portion and adopting the fee schedules of those companies. By doing so, the personal injury carriers are literally paying pennies on the dollar for your claims if you have inclusion in the managed care companies partnered with the personal injury carriers.

 

If...you are in a MedPay state, you must analyze your practice and find the contracts you signed with the managed care companies (if you are a member) and look at the provisions for automatic re-enrollment. Should you choose not to stay a member of that company, you must follow the prescribed manner in which to "drop your membership."

 

I would do the following:

 

1. Call the personal injury carriers in my region and ask what managed care companies they contract with.

 

2. See if I am part of any of those managed care plans.

 

3. Do a cost analysis to see if what I am gaining with managed care vs. personal injury.

 

4. If I realize that I am losing too much, I would withdraw from the managed care company(ies).

 

5. Send all correspondence certified, return receipt.

 

Many doctors signed up with a managed care company 5+ years ago and never treated a patient with that coverage only to find the reimbursement to be a small fraction of the usual and customary rate with the personal injury rate. This is a prime example of the 6 P's. Investigate and analyze your practice. Do not work for $15 per visit with a $20 dollar co-pay when you can get $100-$150-$175-$200 per personal injury visit...UNLESS you are stupid enough to practice in New York and realize there is no difference...wait...that's me!!!!

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