Academy of Chiropractic Personal Injury & Primary Spine Care Program
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“The Lawyer 's Managed Care $$Money Grab$$”
Doctor, please bill my client’s managed care carrier
“I like getting paid....I'm worth it” Mark Studin 2018
It is abundantly apparent that lawyers nationally do not understand that “screwing doctors” by doing a manage care money grab is not in their best interest. Lawyers in every state in the country have realized that if they can get the doctor to bill at the managed care rates, it will create more money being leftover for them take from the settlement or verdict.
This issue has become a national epidemic and one where most of our doctors are poorly equipped on how to communicate effectively with the attorney so as not to destroy the relationship with the lawyer while ensuring full payment. To be able to understand the relationships, you must first understand what insurance to bill based upon the financial class of the patient.
Worker’s Compensation: Billed for on the job injuries
Medicare: Billed as primary for all recipients
Managed Care: For all non-work or auto-related diagnosis
Personal Injury/No-Fault/PIP: Billed for all auto-related injuries
It is that simple. From my perspective, although it is not illegal to bill out of the financial class (except W/C in some states), at the end of the case the various carriers will subrogate (back-bill) the responsible auto carrier because by billing rules and many laws in some states, you must indicate that the cause is from a car accident on the claim form and the paying party who is honestly not responsible, will want to get reimbursed. If the lawyer wants you to bill outside of the responsible financial class it is not illegal, but possibly unethical should there still be active benefits under other coverage. Should there be no coverage, you should either lien or do a letter of protection from the case to get paid.
The auto carrier has to be responsible for auto-related injuries. It is that simple.
This issue has become vogue nationally over the last 2-3 years, and lawyers realize they can leverage you to charge less, which leaves more for them (their money grab) in the settlement. Also, and perhaps most relevant, too many doctors regardless of training are not officers of the court and poorly equipped to refute the request from the lawyer.
Therefore, here is the language that I would consider using:
“I understand your request. However, the injuries were caused by the accident, and I have an ethical responsibility to both report and bill the injuries to the auto carrier or the responsible party either directly or through you.”
Here is the caveat; if you have billed the auto carrier and your patient was denied care or benefits were exhausted, then you have a decision; Should you lien or require a letter of protection vs. bill the managed care carrier. This is a business decision based upon YOUR reimbursements and not a legal one as long as you check off on the claim form that the causality was from an auto accident.
The first thing you need to do to make that decision is a profit and loss statement to determine how much it costs you to process EVERY patient in your practice, not just personal injury cases. If the managed care reimbursement leaves you with no profit, or at a loss, the decision is easy. However, this solely depends upon the reimbursement amount. As a note, Medicare will 100% subrogate the case, and I would NEVER take Medicare over an auto carrier as payor.
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Graduate Medical Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences
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