Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1100
Office Systems 95 OS
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
Insurance company wants to cut my PI bill with no lawyer
Dr Studin: You have a patient that finished care six to seven months ago. They were in a car accident but no lawyer because it was a low speed crash, which I think is absurd because you know that's still something a lawyer can work with, but now the insurance company doesn't want to pay the bill. They're giving you a low-ball offer and not paying your bill. Correct?
Doctor Guest: Correct.
Dr Studin: Did they call you or send you a letter?
Doctor Guest: They called us.
Dr Studin: The first thing you do is you tell them to make your offer in writing. I do nothing verbally over the phone. And just like I'm recording this conversation right now, there is an app you could put on your phone called tape a call pro. You should put that on and record every conversation with the insurance company, now you can start recording the conversations when the carrier start lying, and you have proof that they lied. So send them a letter, here's your bill and please respond with their intents of pay, you got to get things in writing cause that's just how it works, and they're going to send you a bill stating that like I'm sorry. It's a low speed crash, your bill is $5,000 the most we can pay you as $2,000 and someone's going to sign it or maybe even not sign it because this is what the carriers do. They don't want to have a level of responsibility, but you need to get a name of a person because the next letter you're going to write is, dear insurance company, I am in receipt of your offer of paying 40% of my bill. Could you please give me the name of the licensed provider who made that clinical determination that 60% of my care what's not necessary. I am an evidence-based provider it was all based upon evaluations and reevaluations. Therefore, I'd like a copy of the report of a licensed provider who made that clinical determination. In absence of that, I will assume you the claims rep made that clinical determination and in the state of your state according to section 262.10 that is practicing medicine and or chiropractic without a license and is a felony in this state and will be reported to the district attorney's office as such. Therefore, I'm requesting send documentation within five business days. If in five business days, you don't get because you are not going to you then send a letter that say I am now rendering unless this is paid in full. I am now rendering a complaint to the Department of Insurance and speaking with the local district attorney for infraction of this law. And you render the complaints. 85% of the time the check is in your office in two days because they broke the law. A non-licensed person cannot make a clinical decision. Now they send the report over from a licensed person. That's a whole different issue; in some states they have legislated in that claim’s rep can make these levels of decisions, which is stupid because they're saying, I just don't want to pay and not giving a reason why. Now it's pretty interesting that politically you know which state those are usually, and this is not to say you should be a conservative or liberal. This is just telling you, giving you an indication, of which was going to happen in your state. Because usually in the more conservative states side, usually with the insurance companies because the courts are more conservative, and they go and they support big business more than they support the individual. That's just the politics of how we run our business. In the more liberal states, the laws are usually set up to support the patient and the individual more than the insurance carriers. So you happen to be in a somewhat liberal state, the split down the middle, but I know your office is on the liberal side, so you will probably stand an easier chance of getting paid than someone who lives on the other side, saying like Tennessee, which is a much more conservative state. So, you got to understand how the courts work, which is important too. But in your scenario, you got to have that denial in writing, and you've got to get the name of the person you spoke with. Do you have the name of the person you spoke with them phone numbers and they leave you their info?
Guest Doctor: I guess so.
Dr Studin: So what you want to do is have you or your office manager, it doesn't matter whom, get on the phone with this person, get the app I mentioned above and record the conversation and just say hi, I'm calling for Dr so and so's office, I'd like a copy of your offer in writing. I'd like to see what that is, and what's your name again? You know John Smith. Okay, got it. Mr. Smith. Thank you so much. We'll look forward to your offer in writing. We only respond to things of writing. Now you've got them on the phone call saying it's him and when you get the letter and it doesn't have a signature on it, you can say dear Mr. Smith, as per your request, I got the letter, although there's no name on it, I assume it's yours because you're the one that called me with the author, etc; So I assume this is your determination or when you get them on the phone say: “listen, is this your claim? Is this your case? or you're making the call for someone else? Because when I respond my letter, I'd like to know who to respond to”. You got to play a little bit of cat mouse game to get name of the person you got to adjust the letter to. Then when you get the letter, call me and then we'll go to the next step of work on getting your paid.