Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1096
Office Systems 91 OS

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. -Mark Studin 2006

"Lawyer not paying me and I didn’t do what I needed to get paid"


Dr Studin: I'm going to read you a letter that was just sent to me from one of my doctors and this was a $13,000/$13,200 case that he had to lean on and the lawyer dispersed all the money to themselves and the patients, they did a money gram and the lawyer claimed that they spoke to the doctor's office and said there was no lien on the case, which is not true. And the doctor said because you didn't pay the lien, we're going to report you for it to the state bar for an ethics violation, and that's the licensure board, and they are going to lose their license for that stuff. Here's what the lawyer wrote: “First the asserted that my staff calls in this idea of the zero balance, which is a thorough fabrication, but he wrote, I would prefer that to professionals such as us discuss solutions rather than lodging threats such as the advice I shared with this patient, my client this morning when expressed her concerns that your undisclosed billing rates for their car wreck are exponentially higher than was charged for prior treatment, which was a cash. While such artificially inflated, those may be improper, unethical, threatening. You would be counterproductive to resolve the underlying issue. Meaning that the lawyer is threatening back in a very nice way that you threatened me, that I paid it. Well, I now have leverage over you. So, Christie, what is it that your company does specifically that resolves these issues? Even though the stupid idiot moron, doctor, I didn't use a bad word yet, but I really want you to, was at the seminar when you and, and Dr Foxworthy presented and explain how this not to happen. And I told him to take action now, but now he's got to give up $13,200 for this case. And probably every other case he didn't have proper paperwork. So, what is it you guys do?

Guest Doctor: What Chiro Health USA does is that it allows you to set your actual fees or in this case has PIP as your highest fee that you're billing out that you're able to collect that $13,000 while still having a affordable rate in your practice for your patients who have minimal chiropractic care insurance, no chiropractic care insurance, high deductible, and even if you're treating your medicare patients only adjustments are covered, nothing else so that you're able to give them a portable options with the lower rate that you set within your chiro health fee schedule.

Dr Studin: When you say lower rate, you mean cash rate, Correct?

Guest Doctor: Well, a lot of people replace their cash fee within their practice with the Chiro Health USA fees and that becomes the contractual network discount in your practice. So, you're eliminating that dual fee schedule that apparently this particular doctor that you’re saying that he has this lower cash fee versus what he billed out to this particular client.

Dr Studin: What makes it legal for you to have a two-fee schedule when the doctor is considered improper and illegal for the doctor to do it? Why is it that you can do that?

Guest Doctor: What makes it legal is the actual contract that we have. So, there's a Chiro health USA as part of a discount medical plan organization and companies like ours have been around for over 30 years. The caviar to that is most of them are owned by insurance companies, Blue Cross, Blue Shield, Aetna, Cigna. What's different about us is that we are owned by a chiropractor and our contract was written for the benefit of chiropractor’s Dr Fourth wanted to make absolutely certain that any contract he asked another provider to sign was something that he himself had feel comfortable signing. Meaning we don't dictate what your fees are going to be within our fee schedule. You make that determination because we might have a doctor in long island who fees are considerably different than what they are here in Flowood, Mississippi.

Dr Studin: Now what the issue is Dr Foxworth has to apply to the State Department of Insurance in every state to be considered a discount network.

Guest Doctor: Not in every state. They're only regulated in 30 plus states in the country. So not every single one, but most states do have rules in place regarding having a dual fee schedule in your practice or not only that, if you're in network with any insurance companies, there is most likely to cause within your contract, although written in some sort of legal jargons that you don't understand what it means. Not that anybody reads these contracts before they signed them, that says that you're not going to charge, they're not uninsured patients the same thing that you're charging, you are discounting them. You would offer the discounts through blue cross blue, shield patients. So, your fee might be $100. We named Blue Cross is probably paying you like $50, $40. Then you have patients who are coming in who have zero insurance whatsoever and you have your cash fee and you're charging them 40 or $50. So in an honor situation, what they look at is, hey, by the way, we've been paying you $50 a visit all this time because your fee was 100 but in fact, because your cash fee is 50 that means your actual fee in your practice is really $50 not a hundred so we've overpaid you on all of these claims.

Dr. Studin: And this solve that issue?

Guest Doctor: It does. And I think that's the exact same thing that this attorney is talking about is that, you can't bill out $100 a visit if you're charging everybody else $50.

Dr Studin: Therefore, what you're saying is being involved in this particular network gives you a legal vehicle for a two-fee system.

Guest Doctor: Absolutely.

Dr Studin: Now what does the doctor have to do to get started in the network? Tell me the steps that we have to go through and let's make it stupid easy because some of these doctors really don't pay attention.

Guest Doctor: So, the first thing you would do is go to, and that is where you start the application process and you decide how you want to set this up. Fill out an online application that takes like two, three minutes. You're immediately going to get an email. Once you submit that application, let you know that we need the following items from you, that it needs to be faxed or emailed in. The first hit a printout of your fee schedule from your software. If you have no idea how to do that, give us a call we'll walk you through the steps. Number two, we need proof that you have malpractice insurance is the administrative latest copy of your malpractice. If you don't have it, all you have to do is reach out to a insurance carrier, they will even send it to us on your behalf if you let them know. But usually you can download it from the portal.

Dr Studin: Do you have to be named loss pay or no?

Guest Doctor: No, we don't. The last thing we would need from you is your proof of premise liability insurance, which is your business insurance. And that's probably from like all state, it might also be from or whoever your insurance carrier is.

Dr Studin: And this is also called the business overhead policy, BOP

Guest Doctor: That's it. Fax that over so that we have proof that you have that. Once we have all that, we're going to set up a meeting with either Heather or ginger to help you decide what those fees are going to be. We're going to walk you through that step because as it turns out, you've been told what you're going to charge most of your careers so having to make that decision as to what this fee should be contend to be overwhelming but in 30 minutes or less, they're going to walk you through that step, deciding on your fee schedule and then we schedule a training to train your staff on how to have this conversation with your patients. We've had doctors who've submitted an application and been enrolling patients and talking to patients about cover helps USA in 48 hours.

Dr Studin: Does it cost the doctor or anything to get started?

Guest Doctor: Absolutely nothing. There's no cost to the provider whatsoever.

Dr Studin: So, you're explaining to the patient what is it you're explaining? First, I'm going to ask you what you are explaining to the patient and then I’m going to ask you how much it cost to patients. So why don't you do, what are you explain to the patient first.

Guest Doctor: If we're talking to an it patient, especially existing patients, if you've had a cash in your office for considerable amount of time, it's the chance we just wanted to let you know that we've recently been made aware of state or federal regulations that prohibit us from offering you these discounts that you've been receiving in the past. Currently you're paying about $35 a visit. When the actual fees for the service you're receiving are $125 a visit. Now, Dr. Smith wanted to make sure that you were still getting the same great care at an affordable rate, which is why we have covered health USA. For $49 a year, you and all of your legal dependents can get this discount. So instead of paying $125 a visit, your visit will be whatever that dollar amount is that you set, whether you decide to keep it at the cash fee you've been charging the $45/$55/$75 a visit and set it as a cap fee. Super easy conversation.

Dr Studin: And then they fill out an application and send it in with the fee?

Doctor Guest: Yes, and you enroll them right there at your front desk online. They get that discount on the very first visit. It takes two minutes to do this.

Dr Studin: Does the doctor get the certificate, a form, something to give to lawyers like this lawyer who did a money MoneyGram? He just said the money grabbed, so he's making a threat. He would say he's provided; he's enrolled in a discount/network that's recognized in the state that's federally recognized. How would you respond to this?

Guest Doctor: So he would just let them know that they only have a single fee schedule in his practice and the only time it discount is ever offered is if they participate in a particular health plan like blue cross, blue shield by a state or federal mandated program, which would be worker's compensation in some states is PI. So Medicare, Medicaid, and because they participated in a discount medical plan, which the patients have to join, which is for non-covered services only so you don't have to worry about not being paid your full fees in a Pi case because those are covered services under that case.

Dr Studin: Do you provide language for the doctor?

Guest Doctor: Yeah, we do. That would be taken from our sample, financial policy. That's two thirds of the page along. They can fax it right on over to the provider.

Dr Studin: Do you have a lawyer letter, something like that?

Guest Doctor: No, we don't have anything like that, but he could very easily be constructed from the financial policy, which is what I did.

Dr. Studin: Thank you for all the information.

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