"Qualify Insurance and get paid"

Quickie Consult 1188
Lawyers and Medical 87 L

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

"Neurosurgeon wanted to have breakfast with me....What I did"


Dr Studin: start from the beginning please.

Guest Dr: we have a patient that was in a pretty significant car accident and after the accident she did not seek any medical care, we've been treating her for about 50 to 60 days now and we finally received the stack, papers and benefits from state farm stating that none of her care is covered because her policy benefits had been exhausted.

Dr Studin: in your state there's a $5,000 mandatory mentee correct?

Guest Dr: Correct.

Dr Studin: Did she go to the emergency room?

Guest Dr: She did not.

Dr Studin: You're the only provider she saw?

Guest Dr: Correct.

Dr Studin: so the state farm simply said that her benefits have been exhausted?

Guest Dr: on every single date of service.

Dr Studin: did you communicate with state farm?

Guest Dr: We have not yet.

Dr Studin: So, if in a significant accident, are you sure she didn't go to the emergency room?

Guest Dr: yes.

Dr Studin: Maybe they just made a mistake, So the first thing I do when we get a patient in our office, and actually this starts well before the patient comes into the office, do you want a patient to walk into your office and then you spend an hour with them and realize they have no benefits and you're working for free? No. You want to set your business system up to do the following. When the patient calls the office, you pre fill out their forms. So when they come in, there's less for you to do. So now the patient's motivated to give your staff information on the phone. So I say, listen, I'm going to pre-fill name, address, phone number, responsible party, and you said this was an accident. Who's your auto carrier? Would you mind going after your car in your glove box and just get me the policy number that's on the insurance card in your car? I'm more than happy to wait. Well, I'll call you back in a minute. And now they give you the number, not what was the date of your accident? Great. Listen, we're going to see you Monday at bright and early nine o'clock in the morning. Thank you so much. Now you hang up. Now your staff calls the insurance company called state farm. They said they were in an accident, was it reported to you and are there benefits available? They will tell you upfront. Now you call the patient back and say, listen, do you have a lawyer? because your benefits have been exhausted. You went to the emergency room. Oh, I didn't go to the emergency room. Well, I'm holding the record that you, according to state farm, you went to the emergency room and I now have to call the emergency room to get their records. So if state farm made a mistake, can you please call them and correct that record because I can't call them, but I don't want you to walk in and then me to hit you with a bill for $300, which I think is covered a hundred percent sure. And that resolves that issue. So your step now after the fact is to call state farm and say, I got an EOB and it says that benefits have been exhausted. Can you please tell me the dates of the providers and where the person went? So one, I could pull an old records, the patient should have filled out by now that assignment of benefits and rights. And this is where those assignment of rights come in, you have the right to call the carrier, So they've given me the right to do all this stuff. So, and that's where it comes into play. 

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