Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 176
“URGENT - BEWARE”
I received an all too familiar call today from a doctor who asked me what he should do as the insurance company is sending over an investigator about one of his patients. The investigator claimed that there is something unusual about the patient’s claim and they want to ensure that the patient isn’t lying. The particular department of the insurance company is called the special investigative unit or SIU for short. Thankfully, this doctor called me prior to meeting with the investigator and he was smart as most other doctors call after the meeting and wonder why they are no longer getting paid from the carrier; some have law suits that follow.
The SIU is the investigative arm of the insurance company and they often send in young girls or older men who are very disarming. Their jobs is get you to give them your records and charts and gather as much information as they can about you in order to figure out how not to pay you. In many cases, they work very hard to shut you down by discrediting your office for some silly technicality and using that as a reason to either sue you or work with the state board to get your license taken away. I know 2 doctors who are going through that right now.
Is this the case in every instance? No. There are no absolutes here, just caveats. Caveat defined: buyer beware.
Should an insurance carrier want to visit you, the first thing you should do is have the records they're interested in audited by Dr. Schonfeld. You can reach him at 516-695-7732. The second thing you should do is have a health care lawyer communicate directly with the SIU department as you should not meet any insurance representative without your lawyer present.
In fact, I rarely met with any of them during my 30 years in practice; I sent my lawyer the records and the SIU representative went to my lawyer’s office and reviewed the records there. The one time I did meet with the SIU representative many years ago, it took me 8 years to unravel the mess I created because I was so honest and giving. I was a fool as I was a healer and never did anything wrong and I was going to show them! I was a schmuck because I gave them everything they wanted not realizing that they were using this to create a profile on over 300 offices in my state and we ended up getting swept in with those “dirty” offices as they placed everyone in the same group who used the same practice patterns regardless of the facts.
A lawyer would have known better and offered them a very narrow piece of information preventing me from getting swept up in the insurance company game and preventing me from having to pay. It is not personal; it is about the money and they want yours. It MUST be a health care lawyer who is experienced in this field, not your buddy or real estate lawyer or the PI lawyer you created a relationship with. You must have someone who knows this industry. It differs greatly from general law. Be smart and practice wisely; do not trust the wolf in the sheep’s clothing.