Academy of Chiropractic

Quickie Podcast 1286
Office Systems 133 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

LOP v. LIEN and Getting Paid

Dr. Studin: So what's going on?

Guest: Let's say, so the attorney that kind of started working with a while back with some misgivings provided talk. He provided letters of protection for some of the initial patients that we worked with together. Um, I see you wanted to stand the difference between a letter of rec protection and lien. Well, I don't know that lane 70 power here in Ohio, but yeah. Uh, well that's the of protection has more power here. This is my understanding. Yeah. In all States, a letter of protection has more power because the lawyer, the letter protection promises that upfront, you're agreeing to a dollar amount, what the lawyer was going to protect them. That's what your case value was worth. And you agree that you're, you're acknowledging that you're not going to get paid more than that, unless you negotiate them at the backend, a lien is an open-end document saying you're going to treat as necessary, but you're leaning, uh, your payment against settlement.


And, um, theoretically you get paid in full, but the laws and the, and the customs and usual and customary, um, usually don't allow you to get your full payment. So therein lies the difference. I think the way he answered is that, uh, that lien doesn't get any payment and the LLP until I, you to get whatever you can figure out how much you can pay you. So, you know, what, what lawyer is doing as they conflate those two things kind of on purpose. But at the end of the day, they, they acknowledge all those documents do is acknowledge. You're going to get paid. That's really getting today's marketplace. And then you have to deal with the lawyer. So let's talk about what the lawyer is doing to you. And then we're going to talk about what possibly could be done, uh, what could have been done to protect you, and then what action steps you need to do to ensure you get paid. So once the lawyer, so now we've already, prior to this, we use much more colorful language, but let's just say you're dealing with a scumbag law firm. Okay. But we did, but we did use much more fun language than that. That one, one quote that I really love is there's a neuropsychologist I'm friends with there'll be here. And he says that this law firm takes big cases and turns them into little cases.


It's kind of a churn and burn operation, but it's very, it's very, it's very common across the country. And churn and burn is, is not, is not, it's not new. It's been around for, you know, I'm in the game for 40, for 40 years and it's been around for since the beginning, but we'll, we'll give you solution. Okay. What's going on with your kids. So yeah, some of your colleagues in the same firm have actually been pretty good job of paying me, but this guy is like the worst. He, uh, the first, first he calls me on this one particular client and he says, uh, first off he tries to tell me that SIU is investigate me. I'm like for what? And then he tries to tell me that he doesn't understand that somehow the patient's been referred to some chiropractor in Tennessee and some chiropractor in Wisconsin.


And then what I figured out was he's referring to radiology for a chiropractor, dr. Dorn Nicholson in Tennessee. And then, uh, and then just prompts. Um, it's about the genetics. The radiologist is actually a medical radiologist, not a chiropractor who did the now also of ligament injury and Wisconsin. And he, he said like he was on drugs. I mean, she was trying to explain that. And I'm like, what are you talking about? And he's told me that, uh, the only thing that patients had was a hip injury and I over-treated did all this stuff I didn't need to do. I go back to the emergency room records, munchie room records say that the patient has, they complain of back and neck pain doesn't even mention the hip and it might be to even review the records. And so this is, this is the patient's attorney.


Yes. It sounds to me like the patient attorney is reading a peer review report from the insurance company and quoting because he brought SIU up. He's quoting what the peer review peer reviewer said about you and your treatment. So would that be an accurate statement or, you know, I'm not sure. I think it's an accurate, I mean, uh, we're talking, we're talking facts that you factually know that that's what he did or he's not, you know, no, he hasn't called me. I said, I have no idea where he, yeah, this depends on one paper time. Okay. The first thing you need to do is conduct. Okay. Cut law firm and request a copy of all the insurance company correspondence, specifically, uh, peer review reports or, um, or claim examiners reports regarding your care. Now, do you have a release of records? Uh, remember when we did the compliance review, it said I irrevocably authorize my lawyer, et cetera, to release any records to me. Do you have that in your file or something? Um, well, I, I have it now. I don't, I didn't have anything that I think is, uh, do you still have a relationship with that patient?


Well, I don't know. I'm wondering if the attorney has told his patient that, um, I'm a, I'm a scumbag and maybe I don't, I don't know. Then what you do is you call the lawyer and you say, I'd like you to send me when you can speak to the paralegal, try to avoid her talking to the attorney because the lawyer's clueless speak to a paralegal. Or if you have a relationship with another lawyer in the office, try to get to someone in that office and say, we, um, I spoke to mr. So-and-so, who had said that the insurance company made inflammatory comments about me. And, and, and this stated the facts of my patients, bodily injuries, your client, your firm's client. And I'm trying really hard so that you could prevail in your case. So I need a copy of that report so I can respond to it, which will help bolster your case.


But you need to see a copy of that report, I guess, without that you're flying in the dark. Right? Well, I actually have my attorney Rob at this point because, um, I mean, with the financial responsibility form that I was using the cutest, like you didn't lie. If I told that actually imitates an ethical responsibility that they have responsibility to not just me. Um, no, no, that has nothing to do with it. So what did your lawyers say? Go ahead. He said he had a conversation with him and he admitted, he initially tried to say, look, I'll pay you $30 per visit on the claim. I said, that's a minstrel. I'm not going to accept that. That's what my attorney started communicating with them and said, yeah, because you have an ethical responsibility that goes into it. They said, well, actually, it's in trust. And supposedly all the other providers are taking 80 to 90% of reductions, which I find hard to believe.


Yeah, that's what everyone else is doing is that all of that is not relevant. Okay. The only thing that's relevant as you have a bill and it needs to get paid. Now, you haven't gone. You haven't, you're not long enough for the program to understand the, um, negotiation tactics for links or lettuce or protection. But this case it's a lien. So you, you, you, you haven't really listened or read any of those things. There's a formula and you'll get to that. Okay. Before you you'll just have to listen faster and then read faster. So what I don't want to do is start giving you the, everybody wants all the information yesterday. It's too much. I'm going to overwhelm you. My answer is just keep doing whatever you've normally done for now. And yes, you're going to get, yes, you're going to get screwed now. You just are.


Okay. And, um, he, I, it's a $5,000 bill. Um, now at this point, he wants to know if I will take a, a thousand dollars on $5,000 bill. And my back is still not the issue. How much was the settlement? No. See, that's the problem. I told my attorney. I need to have a dispersant. I need to know how much the settlement was in order, in order for you to consider a reduction of your fee. Number one, you need a full accounting, a full disbursement sheet, but number two, and let's just make this easy. And you'll learn more about this later on, you're a team player. You are willing to take the same percentage reduction that the lawyer takes of their third. Yup. Whatever, whatever, whatever, whatever less they take, you'll take because you're a team player. If they're not willing to take any less than you're not taking any less.


Good. I see. I agree if they hear it, he's saying that he does. He's he's going to take this full on my out. And he's like taking everybody else reduced because he did all the words. Okay. So, so, so stop laughing, stop. You'll learn more. You'll learn more about this. As you move on, lawyer did a lot of work I'm sure. Okay. And, and, and you can, you can tell the attorney that, uh, what percentage and here's the thing. The average chiropractor is overhead is 50 to 55%. And what you tell the attorney is just say your overhead, 55, 50%. My overhead before taxes is 50%. So if you expect me to take this number, then what you're doing is asking me not to work for free, but to pay you and the patient so that you could make money.


Okay? Because we all have our expenses, we all ever overhead and we all, and I'm sure you did a lot of work, but so did I, which is why I'm a team player. I'm willing to lose money if you're willing to lose money. But if you are not willing to lose money, then don't ask me, and that's how you approached this for now, for now. But you also don't have all your ducks in a row. You don't have all your appropriate documentation. You don't have all the different things that say, you start with this lawyer. Now, one of the things that I'm going to, and this is the third phone call in the past two days of a similar nature I created, uh, about six months ago, um, a new program and I have a website for it. And, um, I haven't released it. And I'm not sure when I'm going to it's called case percentages.


And what it does is, is when you get an initial offer from a lawyer, in other words, this is a 20% offer. You're going to post on this website, the name, the law firm, and the initial offer, uh, that initial percentage offered. You're going to post it. And then when you get final payment, you're going to go in and put not the dollar amount, but the, but the final percentage paid. So now this attorney is going to be profiled for the whole world to see what percentages are being paid on, on liens so that you in the future and other people in the future will know what this lawyer does. So therefore you will be able to go. And I don't know how many people it's new. So you might be the only one posting this in your community for now, but you can also share with your colleagues to go on there and post.


Um, but you will go in, you will now have the ability and the knowledge and the power to see if you want to accept cases that this lawyer represents in the future. Now, the other thing you could do is if you have relationships with other attorneys in that firm is let them know that not only are you not taking cases of VAT, particular lawyers representing them, because as far as you're concerned, he's unethical, um, or just not a good lawyer because he doesn't get good results, but you are letting your colleagues and all your future patients know that if they're working with him and your law firm, that they should switch attorneys, knowledge is power. And those that control the referrals control again, can accuse me of defamation. Well, you're not you're you're no, because you're, you're you're I don't think so. I haven't published this yet.


Decimation, is this something you do in writing? You're not, you're not defaming him in writing. All you're doing is reporting what they offered you. How is that defamation? You're not saying it's bad, but I tell his colleagues. I'm going to tell everybody not to use them. Is that well, you're telling your colleagues that I'm going to tell, I'm going to tell my client, my patients, that you know, that I can't treat you because he, you know, he, he offered me less than the cost of my care. And, and I can't treat you. And if you want to go to a different lawyer who does a better job, um, you know, that's your choice. There's ways to articulate it. So it's not defamation. You understand? And, and there's, there's a lot of ways to articulate that, but it's time to get real. And you will no longer accept patients that have this lawyer that represents them, but you need to let them, you need to let that firm know that you need to let that firm know that I like working with your firm, but this particular lawyer, if I have a client that he represents, I'm going to tell that client to consider switching to another returnee, because w we're going to go bankrupt dealing with that lawyer.

And, you know, and, and from what I was seeing from my pitch, the feedback that I get from my patients, um, nice person, great everything right down to how much money they get, which is not a whole lot. And everyone gets screwed all the way down the line. My surgeons don't want to work with them. My, my radio imaging companies don't want to work with them. I don't want to work with someone. I'm letting you know, I'm going to tell patients that this is who you're working with. And I'm going to let my colleagues though, what, what, and I'm going to tell my colleagues, not that he's good, bad, or different, but this is what they're offering us in a percentage. And they can make their own decisions if they want to get into that relationship. So you really, you could really slam the sky in a very polite non-litigation way.

Cool. Don't put it, don't put it writing, write slander is what you say and hard to prove. Defamation is what you put in writing. Just the word verbally. Cool. Okay. Excellent. And some of our conversations either asked me if I was recording it. And unfortunately I wasn't, but I guess they could, otherwise, I guess if it's from one, two, they could turn around and say, well, we'll do the same thing to you. Okay. That's fine. That's fine. That's fine. There's no problem. No problem whatsoever. I ask you this now, um, in the conversation with my attorney, I'm sorry if I'm talking too loud, uh, he, he told me that now he's kind of bluffing this guy. Cause he's saying that he has a friend at the bar he's talked to these, does that, um, there may be an ethical obligation to make sure it gets covered.

The patients still want to have an agreement, but he said that in all honesty, as a practical matter, uh, and as a goal, um, complaint probably won't be after to the pond. And I'm wondering a day that you do have an agreement, which is even more powerful than what I am, but the answer is, is I will render that ethical complaint regardless. Cause I want it on, I want it on his record. And if I have the same thing with another patient, I'm going to render an ethical complaint. And if my colleagues have the same problem with them, they should render an ethical complaint. Now, all of a sudden, when the state bar, which is a licensure board, starts to see two, three, four ethical complaints, they can ignore all of them. Right. That's what I thought. Okay. Now was there a med pay provision?

Not that I'm aware of. No. It was known that thing. Okay. Okay. So, okay. So you know what you need to do? Yeah. What's that? Okay. Well, we've been talking about it. Okay. Um, you're, you're going to, you want to get a copy of the reports from the insurance companies, because you want to, um, you want to be able to respond to them. You want to see what they're saying? You have to respond to them and then you want a copy of this first one sheet and you're willing to take whatever reduction in percentage they are. And you can put that in writing because you're a team player. If they are not willing to take a reduction, you're not willing to take a reduction. And are you sure there was no med tech that they've settled the case and the money's from third party? That's my understanding. Yeah, no. When I checked, I don't think he in Kentucky had an out, I don't even know if he had again, insurance, to be honest. And you have to make sure there's also no UN and UIM. Right? So all of those things come into play list is the oldest thing I can tell you is you're just getting started in the program.

I love the fun about this program and talking about with case personally. So I'd love to get that too well, we'll work on that, but that's secondary. Just get through those podcasts really fast. We are everything, all of these things are going to be handled. Everything you just said. Most of my docs who have been trained, don't stress over this stuff anymore. They become the ones in control. That's the power that's awaiting you once you get educated. Okay. So, uh, I I'm, uh, now, um, yeah, I'm going to be, I've gone through a little bit of the console every day and I'm planning on Sundays, gonna be my day where I'm just to sit down and pour everything pretty much that yeah, my answer is, is don't do it all in one day. Um, no, because it's too much information. You're going to be on overload.

So, you know, you, you can't change your habits of, of, of waking up having breakfast, exercising. If you do going to work, you know, reading the paper, these are the things you do. It only takes two things to get through this really well and gracefully. It's long days of sleepless nights and there's no shortcuts. So set your clock and wake up a half an hour earlier and go to bed a half an hour later. And just before you, when you wake up, listen to one or two podcasts before you go to sleep, listen to one to two and during lunch, maybe listen to one or two and you're not talking to because most of them are between five and 15 minutes. So you you'll be able to get through it a lot quicker, sitting down just on a Sunday in a blitz is it's going to be too much information.

You have to do this invites because it has to marinate. Okay. What are the things I'll make a note of here? We'll put to now one of the things that supposedly I'm being investigated for risk using too many diagnoses and okay. No, no, no. That's, that's that supposedly does it mean to anything? Is that the same lawyer? Yes. So one copy of it. You want a copy of the report that he has? Yeah. Okay. Because that's part of what the carrier's tactics are. You need a copy that goes back to the same thing. You need a copy of the report of what you should be entitled to. So you can respond to it. My attorney said new one, that's attached and by the insurance company and he leaves to the, he needs to fight that you need to respond to that. He can fight it.

You need to respond to it. You get a copy of it. I want to tell ya a few weeks before I had that communication, I was told by one of my staff that, uh, an SIU investigator from gray, this insurance don't they had somebody, when we were closing up, I, I, I took the information to my attorney and gave them all and said that they could, uh, we contact them, but they need to protect me if they show up again. Right? Yeah. You never talked to him. We handle that in the consults also of how to handle investigators that come in. So, and you did the right thing. You tell them nothing. You say nothing. You don't allow them in you office beyond the reception area. And here's, here's the phone number of my lawyer. You give him a call, whatever you need. So, but get a copy of that report from another person. Okay? Okay. I'll this have my attorney, shall I have my attorney contacted to say, look, uh, my doctor needs to get all the [inaudible] you can ask. And if then they deny then have your attorney know, okay. I'm going to have them do that then. Okay. You got it. All right. Thanks doc. Appreciate it. Bye-bye.


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