Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1179
Office Systems 107 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
"Billing Managed Care for PI"
Dr Studin: what's going on?
Guest Dr: So I have a patient who I had treated for an original car accident.
Dr Studin: how long ago?
Guest Dr: The original one was a September last year. And I had treated her for a little while. The PIP after I got a bill, I got the $2K I got, actually I got one payment and then I got the $2K exhaust letter. So after that I send it to the health insurance. I thought I called to verify the insurance. I thought it was in network with, it. Turns out I wasn't a fit with the health insurance, so they didn't reimburse me. By the time I got all that information, she had had another car accident, she was in the hospital. It was pretty serious. But when she came back, started treating her again for this new injury, and within a month or so, I got the $8,000 PIP exhaust letter, however, this is all at the same time I'm finding out that her health insurance isn't covering it anyway, when I originally called, they said I was and then I wasn't, in the end it turns out I not in that network and they're not going to reimburse me for it, but I continued to treat the patients, just figuring when the settlement comes we'll figure it all out then. So I got a call today from the attorney. I've been sending things off to them periodically and he was calling too for the first case to find out, what I'd be willing to accept for that, and I'm like, Oh, so this is for the first, not the second. He's like, Oh the second case that's already settled. And I'm like, really? why haven't I heard anything about that or been paid or anything. He's like, well let me get back to you. Call me back today. And he was going offer me… between the two cases I have outstanding.
Dr Studin: what percentages you offering you on both cases?
Guest Dr: it ends up being like 25%.
Dr Studin: So here's the issues, you've got a whole bunch of problems here. So the first case issue is do you have liens signed on both cases?
Guest Dr: Yes. For both.
Dr Studin: Did you send it to the lawyer? Return receipt, green card and fax it over two forms of verification?
Guest Dr: No, I didn't do all of that, No.
Dr Studin: What did you do?
Guest Dr: On the first one I did do return receipt. The second one I think I sent over a copy of it with bills.
Dr Studin: So, you don't have any proof he received it?
Guest Dr: No. not the second one.
Dr Studin: so that's your loss, because you're screwed up, but for the first case, how much was your bill?
Guest Dr: So total right now it's a little over a thousand.
Dr Studin: And how much for the second case?
Guest Dr: it's about $3,700.
Dr Studin: Number one. When care is denied, you don't put it through managed care. It stays on the PIP side. That managed care requests by the lawyer and or the patient is at the suggestion of the lawyer is a money grab because they want you to bill.
Guest Dr: So, you don't have to bill the health insurance.?
Dr Studin: NO! it's a personal injury case. This has nothing to do with managed care. It's more like the other way around because ethically why would you build manage care when All State should be responsible and not blue cross blue shield. So you should never bill a managed care. Secondly, 2 forms of proof. Third, you have leverage over the first case for the lawyer. Not the second. Cause you have verification. They received the lien prior to disbursement of the funds, But the funds were dispersed so you got nothing for the second. You could go after the lawyer for the first case and win 100% and take the lawyer's license away if he doesn't pay you. But the second case, you have no proof that they received them. So he's offering you a thousand dollars for both cases?
Guest Dr: $1400 I think for both.
Dr Studin: Tell him $2,500 and you call it a day. And if he says $2000 then tell him $3000, So he says, okay for the $2,500. you can’t play hardball here. You got no leg to stand on, if you sent that letter in either a certified receipt or fax or the fax back, then you would have got paid in full on