Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 36 CA
"Surprise Visits by the Insurance Company"
If an insurance company representative should show up in your office unannounced and have any level of request, your answer is only one word, "NO!" It doesn't matter what they're requesting or why they're requesting it. 99% of the time it is from an SIU (special investigative unit) whose sole purpose is to find faults in your office so that the insurance company can either not pay you, get repaid from you retrospectively, or institute a lawsuit. They are on a "fishing expedition" and you are " the catch." The staff of the SIUs get paid to do just that.
Often, the carriers will send 2 people; one will be the good guy and the other the bad guy to "play you." In some instances, they send "cute young women" to entice you to give more than you should or would if your guard was up. Many doctors get indignant and feel they are great healers, are doing nothing wrong or "screw them" and give them information just to put an expeditious end to the process. Others simply get scared and offer anything they are asked for. Often, SIU investigators want to take pictures of your office and get copies of sign-in sheets and records. All of the above can end up costing you lots of money and sleepless nights unnecessarily.
The answer to everything is, "NO, NO and HELL NO!!!"
I have said this before and I am saying it again. If any representative from any insurance company appears in your office for any reason, you are to be polite, do not invite them to walk past your front desk and request his/her card. Inform him.her that your lawyer will be calling him/her to comply with any request he/she has through your legal representative.
You have no contract with the carriers. Therefore, you have no legal obligation to comply with their requests. You do want to get paid, but your lawyer will ferret out what needs to be answered and what shouldn't and how to answer it so that you do not give the carriers any leverage over you.
Should this be a managed care company that you DO have a contract with, the same rules apply. You are complying with their requests, only through your lawyer and that is usual, customary and legally defensible. THIS IS NON-NEGOTIABLE!!!!