The Problem

Sometimes it seems that the gains made by treatment can be offset, at least in part, by the cost of care, the patient’s time away from gainful employment and the inconvenience of the treatment process. This is especially true for patients who are living on-the-edge financially.

What, if anything, can the physician do about it? Should health care providers assist patients by guiding them to insurance benefits and financial remuneration that may be available as a result of an injury?  How proactive should a physician be in directing patients to benefits of which they may be unaware?

A Solution

Let me suggest a paradigm shift that could be a win-win for both patients and health care providers:

The intake process could include gathering specific and targeted information that directs the patient to sources of reimbursement for not only the doctor’s fees but other compensation as well. Often, there are substantial benefits available to patients that are overlooked.  For instance, if your fees have been paid by the patient with a check or credit card, why shouldn’t he also be reimbursed through the medical payment benefits of his auto coverage?  And after your fees have been reimbursed to the patient, why shouldn’t he also pursue compensation from the driver who caused the accident?

The “Double-Dipping” Dilemma

Consider the all-too-common fact pattern which frequently results in soft tissue injuries to motorists who find themselves in need of chiropractic care for relief:  The patient [“Driver #1”] is stopped at a traffic light while running an errand for his employer. He has auto coverage which includes medical payment benefits.  He also has health insurance. Driver #1 is rear-ended by another motorist [“Driver #2”] who is also on-the-job and distracted by an incoming text message. Driver #2 and his employer have automobile coverage.

What are the potential sources of reimbursement to the patient?  1] His med pay coverage; 2] His health insurance; 3] Worker’s compensation benefits from his employer [remember: the patient was on-the-job when the accident occurred]; 4] Driver #2’s auto liability insurance coverage;  5] Driver #2’s employer’s liability coverage [remember:  Driver #2 was also on the job when the accident occurred]. 

The prospect of multiple recoveries from different insurance companies doesn’t necessarily translate into payments from each.  But it could. The patient would need to communicate with the insurance  companies to find out what the policies say about each insurer’s obligation to pay benefits. Which company is primarily obligated to pay for the costs of treatment? Which is secondarily obligated?  What are the rights of each company to reimbursement for benefits paid [“subrogation”]? 

It may turn out, under our hypothetical, that the patient is entitled to recover two or three times for the cost of treatment.  The prospect of multiple recoveries for the same charges is facetiously described by some claims adjusters as “double dipping.”  The inference is that the patient is doing something dishonest by benefitting financially from the accident.

If double or triple dipping is available because a motorist has purchased protection in the form of insurance or it is a benefit of employment, there is no reason why the patient should not receive those benefits AND also pursue the party who caused the accident for additional compensation. If the injured motorist has acquired coverage from more than one source through the payment of premiums with hard-earned dollars, benefits should be paid in accordance with the policies notwithstanding protestations of “double dipping” by claims adjusters.

Practice Tools to Help Patients

How grateful would your patients be if, as part of the intake process, you pointed them to benefits and insurance coverage about which they were unaware? How much goodwill would you generate if you helped patients find coverage to pay not only your fees but compensation above and beyond your fees?

It doesn’t need to take significant time or energy to ask questions, through the new patient registration process, which prompt the patient to identify insurance coverage and other sources of compensation which will mitigate the cost of treatment. A New Patient Benefits Inquiry form in PDF can be downloaded for free at www.selfhelpautoclaims.com.

Auto Claims Without Attorneys

For a consumer-friendly guide concerning the auto claims process, consider giving or selling to patients a copy of the book, Auto Claims Without Attorneys. Often attorneys are not available to represent patients who have sustained minor soft tissue injuries. The settlement value of their claims don’t translate into sizeable contingent fees which make it worth pursuing for counsel. Patients left to go it alone with the claims adjuster often settle for a fraction of what their claims are worth.

Auto Claims Without Attorneys includes discussions regarding liability, damages and insurance issues in language that is easy to understand for a lay person. The Appendix has many useful forms including sample demand letters to insurance companies which can be adapted for use by the patient.  This consumer guide is available in the store at www.ChiroCode.com and in Kindle through Amazon.  Go to www.selfhelpautoclaims.com for details concerning this publication. Whole sale prices lists are available from the publisher [fitzlaw@sedona.net or 928-284-2190].

This publication is not intended to serve as a substitute for legal, tax or other professional advice.  Laws regarding insurance coverage, liability and damages vary from state to state.  If legal or other advice is required, the service of a qualified professional should be sought.