Dr. Katherine Crafton is a successful graduate from the Spinal Research Institute of San Diego operated by the premier expert on auto collision and recovery, Dr. Arthur Croft. Dr. Croft trains physicians and attorneys on being expert witnesses in court cases and to perform auto crash forsenic analysis. His four module programs are taught around the country and he publishs literature and a website. He has conducted auto crash testings and published numerous research studies on auto cases. He maintains a library of helpful literature and case studies that we can access. Few physicians have completed this coursework. It is considered the gold standard of training in the industry.
The phrase, "Sprain and Strain" is used often to the point where it loses meaning in auto cases. Some of the descriptive language associated with injury diagnosic codes use these terms. They create an impression that the injury was not as serious. A sprain can be best thought of as a "sprained ankle" which produces edema and inflammation. We all know how painful it can be and that it requires some time to look better and longer to get better Also one should know that if you do this too often, your ankle will be unstable, hypermobile and too easily injuried in normal activities. A strain means that a force was introduced into your body causing the muscle, connective tissue, or joint to be forced beyond its limits. In each case, there are degrees of spraining an area or straining an area. One can tear tissue and break bones. There can be internal bleeding with associated bruising. Some receive great forces beyond physical tolerances; the result may be that there is no external bleeding, but the victim is dead, or they could walk away only to learn later on that they had a compression fracture. These more severe injuries also have sprain and strain to other tissues, but they take second stage to the discovery of fracture and the ruptured aorta, carotid, or torn spinal cord causing death. One can strain neural and ligamentous supporting tissue and have long term problems. We will use these terms but these walk away injuries can produce pain and can take some time before they heal.
"Soft tissue" injuries is another term used that implies a lesser injury. It is often more serious to tear a ligament than it is to break a bone. Bones heal more easily and are easier to detect, and will not give you as many stability problems later on. Damaged ligaments are the opposite. They continue to damage for several months following the injury before they can even start to heal. Some never heal and remain torn and undetected. Just because they are softer tissue does not mean it is a lesser injury. This is even more so with neural tissue. A damaged nerve and all associated central nervous tissues do not heal well, if ever heal well. Nerve tissue is very soft. The speed associated with an acceleration force can "snap" ligamentous or neural tissue not unlike the difference between slowly stretching it to the difference of pulled it quickly and having it "snap." Soft tissue does not mean, "Well, they only had soft tissue injuries! What's the problem?"
"Soft tissue" injuries is another term used that implies a lesser injury. It is often more serious to tear a ligament than it is to break a bone. Bones heal more easily and are easier to detect, and will not give you as many stability problems later on. Damaged ligaments are the opposite. They continue to damage for several months following the injury before they can even start to heal. Some never heal and remain torn and undetected. Just because they are softer tissue does not mean it is a lesser injury. This is even more so with neural tissue. A damaged nerve and all associated central nervous tissues do not heal well, if ever heal well. Nerve tissue is very soft. The speed associated with an acceleration force can "snap" ligamentous or neural tissue not unlike the difference between slowly stretching it to the difference of pulled it quickly and having it "snap." Soft tissue does not mean, "Well, they only had soft tissue injuries! What's the problem?"
After most auto collisions, the victims are in shock. They are not just surprised; they are in a physiological state of shock. The body releases chemicals into their systems because of the forces involved, and the victims respond accordingly. They are dazed. Their memories are compromised. It is very easy to say the wrong things and do the wrong things. Trained EMTs know this and sometimes the police know this. No one else gives this enough consideration. It is very logical and to be expected that you will hurt more later on. It is too easy to bravely say that you are just fine and for you to move around and do things.
Alabama Code Statute 27-1-19
On Assignment of Benefits
(a) The insured, or health or dental plan beneficiary may assign reimbursement for health or dental care services directly to the provider of services. Health benefits include medical, pharmacy, podiatric, chiropractic, optometric, durable medical equipment and home care services. The company or agency, when authorized by the insured, or health or dental plan beneficiary, shall pay directly to the health care provider the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the contractor provider, and any applicable interest. This amount only applies to assigned claims. Any company or agency making a payment to the insured, or health or dental plan beneficiary, after the rights of the reimbursement have been assigned to the provider of services, shall be liable to the provider for the payment. If the company or agency fails to reimburse the provider in accordance with the terms of the provider contract as provided in this section then the provider shall be entitled to recover in the circuit or district courts of this state from the company or agency responsible for the payment of the claim an amount equal to the value of such claim plus interest and a reasonable attorney's fee to be determined by the court.
Do not tell your Provider/ER/Hospital that the bill is to be paid by an auto insurer. First secure an attorney and wait to see. Wait for the settlement--nothing will happen till then except for many bills. Use your health insurer. Think about it, if you fell at home, you do not go to ER claiming your liability or home owner's insurer is going to pay them. Formally nothing else has been decided. Bottomline, most providers will refuse the auto carriers and only take a health insurer; only a health insurer will pay them right away. Sometimes if a health insurer thinks there might be a third party auto carrier, they'll hold up payments to providers. This can happen here and has kept us from being paid as we go. In any eventual POSITIVE settlement, the health insurer is reimbursed. In any settlement to your favor, all parties are reimbursed by your attorney. No one will take an auto insurer's "word" of payment. You should not either.
Whenever your health insurer pays out, "medical necessity" is established. This is an important consideration.
You may have to part with your deductible for health insurer services, but that's the contract you made or accepted. But again, do not think a provider wants to mixed up in this issue of micromanaging collections. Hopefully, your deductible is not that high and that your physical needs can be resolved.
Whenever your health insurer pays out, "medical necessity" is established. This is an important consideration.
You may have to part with your deductible for health insurer services, but that's the contract you made or accepted. But again, do not think a provider wants to mixed up in this issue of micromanaging collections. Hopefully, your deductible is not that high and that your physical needs can be resolved.
Your Subtitle text
Auto Recovery
WE NO LONGER ACCEPT ASSIGNMENT ON AUTO CASES. THE MEDICAL COMMUNITY DOES NOT EITHER. PLEASE INFORM US OF YOUR INTENT AS WE MAY HAVE TO PROVIDE CODES AND DOCUMENTATION, AND IF NECESSARY, WE WANT THE FREEDOM TO DECLINE BEING INVOLVED. WE CANNOT PROVIDE SELF PAY FEES FOR NON-INSURANCE PATIENTS FOR ANY INSURANCE CASE. YOU MAY READ THE FOLLOWING TO BE BECOME FAMILIAR WITH AUTO CASES. IT MAY OR MAY NOT APPLY TO YOUR SITUATION.
WE MADE CAREFUL CONSIDERATIONS. WE CAN JUST NOT CONTROL ALL THE NEGATIVE FACTORS IN THIS "AT FAULT" STATE. WE ARE A SMALL BUSINESS AND WE CANNOT FUNCTION WITH DELAYED COMPENSATION, IF AT ALL. WE BELIEVE THE INTEGRITY OF ONES HEALTH CARE FAR OUTWEIGHS THE PATIENT'S COMPENSATION. WE ARE NOT YOUR DOCTOR NECESSARILY TO "RUBBER STAMP" ANY REIMBURSE OF FUNDS. "PAIN AND SUFFERING" MAY OR MAY NOT BE PART OF ANY AUTO CLAIM, AND IS NOT OUR BUSINESS, BUT OUR DOCUMENTATION WOULD INFLUENCE THIS ONE SETTLEMENT THAT MAY WELL INCLUDE THIS AND THE SETTLEMENT WITH MANY PROVIDERS AND VENDORS.
ALL AUTO CARE PERFORMED BY THIS OFFICE MUST INCLUDE FULL SPINAL CARE WITH THERAPIES AND FULL X-RAYS TO ALL REGIONS. ANY AO REQUIRED WORK WOULD HAVE TO BE PAID SEPARATELY OUT OF POCKET APART FROM ANY CLAIM. (SEE AO FEES).
WE HAVE ALSO DECIDED THAT IN THE PRESENT SITUATION WE ELECT NOT TO SEE EMERGENCY PATIENTS AND USE EMERGENCY CODES FOR OUR INTERVENTION. ANY TRUE EMERGENCY MUST BE SEEN FIRST BY A MEDICAL FACILITY AND RELEASED WITH A DIAGNOSIS THAT CORRESPONDS WITH OUR CHIROPRACTIC PRACTICE. ANY ACCIDENT RECOVERY THAT DOES NOT FIRST BECOME RELEASED BY A MEDICAL DOCTOR IS VIEWED AS FAR LESS SERIOUS. WE WOULD REQUIRE THIS INTERVENTION BEFORE WE INTERVENED.
Although auto collision injuries in the past represented only 10% of our business, we have done much to help these patients to return back to more active lives. If we have been serving these patients well, it has not been that we have advertised or gone out of our way to build this aspect of our practice. There were just many accidents and injuries and existing patients needing our help.
Most often, we saw what is called a WALK AWAY INJURY. This is where the party was in an accident where they were able to walk away or leave from the scene. It would also include those parties that elected to go to the hospital and received outpatient care and left the hospital that day without being admitted. Seldom have we seen patients who were treated as inpatients. They may well need our care more than the others after being treated and released, but it did not happen often. We see a vast amount of patients who have had auto injuries in the past, but the cases were closed and/or are so old that the auto insurer would never help with the care without serious litigation. The following information is offered from our experience in helping patients seek financial entitlements from injuries from a recent auto collision.
There are many important considerations in handling an auto claim. Can we help the patient? Do they need an attorney? Will the case resolve well financially so that all parties will be fairly compensated?
We have refused some cases, and have in the past accepted most. We have most often received fair compensation; however, we had too many cases receiving no compensation with a outstanding bill and no one willing or able to make good the situation. Almost always compensation was not received for a year or more.
All cases require more office work, because all cases require reports and documentation. All cases must follow established protocols for establishing a plan of care and must follow the insurance company's perception of what is considered customary. This is never identified at the onset of care, and only becomes a problem at a later discovery after the bills have accrued. The office work involved includes not just the paperwork, but the communications and collections aspects over a long time.
ASSIGNMENT OF BENEFITS
In most cases, the question being addressed is whether we are willing to ACCEPT ASSIGNMENT for the treatment. This means that we are not going to be paid until the case settles; yet we have no control over when and how well the case will close. Often we are being asked by you if we will lend you money for treatment that you intend to pay for by a settlement with an insurance company. Many times it is an adversarial company representing the other side. In most daily business transactions, you understand before receiving services and goods that you are going to pay before you leave the facility. You know this because you see the cash register. You would not imagine "filling up the cart and leave out the door without lining up at the register." Some wholesale businesses have clients who have met credit requirements and have applied for and established an account where they are billed; the auto case business relationship is really unfamiliar to people who do not own their own business. All people understand borrowing money from a financial institution, but it is no different than any other debt with an understanding to be paid later. Somehow, unfortunately, some people tend to view borrowing from a friend, family member, or the physician is different. Whenever people ask to borrow money, in general, they should expect that the lender is considering many customary things: (1) the people's ability to pay for the loan if it does not go as expected, (2) is there collateral, (3) can they put up some good faith money for the loan, (4) a successful completion of loan documents and a review of good credit. (5) can I trust them to do the right thing. These things are always considered but are seldom addressed in the acceptance of assignment. As the borrower, understand that they are being considered whether you know it or not. Medical doctors seldom ACCEPT ASSIGNMENT, because they do not have to. Any health benefit program, if it is active by having met the deductible, will pay toward the bills by contract. Chiropractic coverage is most often very limited in these contracts, so chiropractors who elect to treat auto cases are forced to have to deal with a much later financial settlement, if at all.
Medical doctors and hospitals almost always elect to file claims on your health care for their services auto related or not. Given that all health care for medical doctors is not limited, such as are chiropractic services, it is never an issue unless you do not have any health care. Receiving medical care from an auto accident when you do not have health care can be a problem. It is rare to have an activated BCBS coverage (currently satisfied deductible) in your health care plan for chiropractic services for an auto recovery care. At all times, if you elect to use medical services, you will find them costly with much less doctor contact time. These fees, even if they are initially paid out of your health care program, they must be reimbursed from your settlement. The auto insurance is obligated to pay back your health care insurer out of your settlement up to the closing of the case. This will have a significant effect on the amount of money made available to pay out to you for "pain and suffering" and for your chiropractic fees. We have seen it happen especially when you do not have a case that the insurer evaluates initially as "going to be expensive." The auto insurer is only concerned about the bottom line amount of the settlement. You really should not assume that all of your bills will be paid by the auto insurer.
MED PAY
This is the amount set aside for individual health care needs from your own insurer. In Alabama, only this amount is provided for your care if the accident was deemed your fault. If your insurer pays from the Med Pay for damages when the other party was at fault, they will demand and receive reimbursement from the other party's insurer. This amount will come right off the top of any settlement monies.
Too many people do not know what their Med Pay limits are on their insurance. Do not assume that it is enough. Average coverage is about $5000.00 per individual, and it will not be extended no matter what. If it does over that set amount, coverage would have to be directed to your general health care plan. Cases with liability only coverage have no Med Pay amount.
Also if you are told you have a $5000.00 limit on Med Pay from your own insurance, do not assume that you have a "blank check" to spend $5000.00 and the insurer will cover it. We have found that they seldom approve the amounts that you are supposed to be guaranteed. They will make their own judgment on what they think they will pay and look for any reason to lower the settlement amount. Only the medical bills will be most likely guaranteed to be paid from any $5000.00 limit.
SETTLEMENT ON MOST "WALK AWAY" CASES
If we refer you to a medical doctor or if you elect to have expensive testing from the medical community, it is better for you to settle your case with us first. You would be better off to first settle with the insurer to meet your personal demands and satisfy your bills. After signing off, all subsequent bills for your health care no longer need to be reimbursed from the auto claim. Your health care would meet these needs and the auto insurer would no longer have to reimburse them since your case is closed. There is no loss to you, and you are more likely to be able to settle on your bill with us and have a reasonable pain and suffering payment. The insurer is only concerned about the settlement amount no matter where the funds are going.
If you had very serious long lasting damage that is MEASURABLE and OBVIOUS to the point of WINNING YOUR CASE IN COURT BY A JURY OF YOUR PEERS, you need an attorney and, more than likely, we would not be the primary care doctor. You will never get a large settlement from the insurer on most all "Walk Away" auto accidents. In all cases, to my knowledge, the chiropractic fees and/or medical fees will far exceed any pain and suffering money that could be expected. Often, it turned out that all the victim received from their "walk away" accident is enough to pay these bills only. Often, the first offers and subsequent settlement offers paid only the medical bills and they did not meet the chiropractic bills leaving nothing for "pain and suffering." Most recently, working directly with an insurer, no matter who, we have found that working only with an attorney who signs either a lien or letter of understanding to pay us directly upon settlement is the only way we will be treated fairly.
Medical doctors fees and procedures are very expensive, and if a claim is made, they will always have to be paid back first from any settlement monies, regardless of your wishes; this means the medical community gets paid before you do and before we get paid. They are paid off the top, and the patient and the chiropractor gets paid from what's left over. This is not a coincidence; it is just another part of the monopolization of care into the hands of the medical community. Always the medical doctors have spent little or no time helping you, and the cost of their procedures will tip the scales on the settlement. This leaves very little resources left for other consideration. This is true whether an attorney is involved or not. We prefer to accept cases where we are the initial primary care physician and if it is not resolving well in accordance to the Plan of Care, we do not want to continue to see you and increase the bill. If you elect to see another physician, you will be asked to settle with us by paying us or by settling the case with the insurer so they can pay us. We expect to see the patient no more than 2-3 months for a reevaluation to make this determination. Any thing less than 1-2 a week is viewed as occasional.
Any more often treatments (20+), the insurer views as excessive. They claim that if a patient does not recover after a certain limited time frame, the patient should be referred out to different treatment or released. It's a conflict that cannot end well.
Please do not start your care with us unless you can agree to this. Remember that your own health insurance will pay for your medical bills when the case is closed. Any health or auto insurer will not pay for care that is unique to generalized chiropractic care codes to established insurers.
WE MADE CAREFUL CONSIDERATIONS. WE CAN JUST NOT CONTROL ALL THE NEGATIVE FACTORS IN THIS "AT FAULT" STATE. WE ARE A SMALL BUSINESS AND WE CANNOT FUNCTION WITH DELAYED COMPENSATION, IF AT ALL. WE BELIEVE THE INTEGRITY OF ONES HEALTH CARE FAR OUTWEIGHS THE PATIENT'S COMPENSATION. WE ARE NOT YOUR DOCTOR NECESSARILY TO "RUBBER STAMP" ANY REIMBURSE OF FUNDS. "PAIN AND SUFFERING" MAY OR MAY NOT BE PART OF ANY AUTO CLAIM, AND IS NOT OUR BUSINESS, BUT OUR DOCUMENTATION WOULD INFLUENCE THIS ONE SETTLEMENT THAT MAY WELL INCLUDE THIS AND THE SETTLEMENT WITH MANY PROVIDERS AND VENDORS.
ALL AUTO CARE PERFORMED BY THIS OFFICE MUST INCLUDE FULL SPINAL CARE WITH THERAPIES AND FULL X-RAYS TO ALL REGIONS. ANY AO REQUIRED WORK WOULD HAVE TO BE PAID SEPARATELY OUT OF POCKET APART FROM ANY CLAIM. (SEE AO FEES).
WE HAVE ALSO DECIDED THAT IN THE PRESENT SITUATION WE ELECT NOT TO SEE EMERGENCY PATIENTS AND USE EMERGENCY CODES FOR OUR INTERVENTION. ANY TRUE EMERGENCY MUST BE SEEN FIRST BY A MEDICAL FACILITY AND RELEASED WITH A DIAGNOSIS THAT CORRESPONDS WITH OUR CHIROPRACTIC PRACTICE. ANY ACCIDENT RECOVERY THAT DOES NOT FIRST BECOME RELEASED BY A MEDICAL DOCTOR IS VIEWED AS FAR LESS SERIOUS. WE WOULD REQUIRE THIS INTERVENTION BEFORE WE INTERVENED.
Although auto collision injuries in the past represented only 10% of our business, we have done much to help these patients to return back to more active lives. If we have been serving these patients well, it has not been that we have advertised or gone out of our way to build this aspect of our practice. There were just many accidents and injuries and existing patients needing our help.
Most often, we saw what is called a WALK AWAY INJURY. This is where the party was in an accident where they were able to walk away or leave from the scene. It would also include those parties that elected to go to the hospital and received outpatient care and left the hospital that day without being admitted. Seldom have we seen patients who were treated as inpatients. They may well need our care more than the others after being treated and released, but it did not happen often. We see a vast amount of patients who have had auto injuries in the past, but the cases were closed and/or are so old that the auto insurer would never help with the care without serious litigation. The following information is offered from our experience in helping patients seek financial entitlements from injuries from a recent auto collision.
There are many important considerations in handling an auto claim. Can we help the patient? Do they need an attorney? Will the case resolve well financially so that all parties will be fairly compensated?
We have refused some cases, and have in the past accepted most. We have most often received fair compensation; however, we had too many cases receiving no compensation with a outstanding bill and no one willing or able to make good the situation. Almost always compensation was not received for a year or more.
All cases require more office work, because all cases require reports and documentation. All cases must follow established protocols for establishing a plan of care and must follow the insurance company's perception of what is considered customary. This is never identified at the onset of care, and only becomes a problem at a later discovery after the bills have accrued. The office work involved includes not just the paperwork, but the communications and collections aspects over a long time.
ASSIGNMENT OF BENEFITS
In most cases, the question being addressed is whether we are willing to ACCEPT ASSIGNMENT for the treatment. This means that we are not going to be paid until the case settles; yet we have no control over when and how well the case will close. Often we are being asked by you if we will lend you money for treatment that you intend to pay for by a settlement with an insurance company. Many times it is an adversarial company representing the other side. In most daily business transactions, you understand before receiving services and goods that you are going to pay before you leave the facility. You know this because you see the cash register. You would not imagine "filling up the cart and leave out the door without lining up at the register." Some wholesale businesses have clients who have met credit requirements and have applied for and established an account where they are billed; the auto case business relationship is really unfamiliar to people who do not own their own business. All people understand borrowing money from a financial institution, but it is no different than any other debt with an understanding to be paid later. Somehow, unfortunately, some people tend to view borrowing from a friend, family member, or the physician is different. Whenever people ask to borrow money, in general, they should expect that the lender is considering many customary things: (1) the people's ability to pay for the loan if it does not go as expected, (2) is there collateral, (3) can they put up some good faith money for the loan, (4) a successful completion of loan documents and a review of good credit. (5) can I trust them to do the right thing. These things are always considered but are seldom addressed in the acceptance of assignment. As the borrower, understand that they are being considered whether you know it or not. Medical doctors seldom ACCEPT ASSIGNMENT, because they do not have to. Any health benefit program, if it is active by having met the deductible, will pay toward the bills by contract. Chiropractic coverage is most often very limited in these contracts, so chiropractors who elect to treat auto cases are forced to have to deal with a much later financial settlement, if at all.
Medical doctors and hospitals almost always elect to file claims on your health care for their services auto related or not. Given that all health care for medical doctors is not limited, such as are chiropractic services, it is never an issue unless you do not have any health care. Receiving medical care from an auto accident when you do not have health care can be a problem. It is rare to have an activated BCBS coverage (currently satisfied deductible) in your health care plan for chiropractic services for an auto recovery care. At all times, if you elect to use medical services, you will find them costly with much less doctor contact time. These fees, even if they are initially paid out of your health care program, they must be reimbursed from your settlement. The auto insurance is obligated to pay back your health care insurer out of your settlement up to the closing of the case. This will have a significant effect on the amount of money made available to pay out to you for "pain and suffering" and for your chiropractic fees. We have seen it happen especially when you do not have a case that the insurer evaluates initially as "going to be expensive." The auto insurer is only concerned about the bottom line amount of the settlement. You really should not assume that all of your bills will be paid by the auto insurer.
MED PAY
This is the amount set aside for individual health care needs from your own insurer. In Alabama, only this amount is provided for your care if the accident was deemed your fault. If your insurer pays from the Med Pay for damages when the other party was at fault, they will demand and receive reimbursement from the other party's insurer. This amount will come right off the top of any settlement monies.
Too many people do not know what their Med Pay limits are on their insurance. Do not assume that it is enough. Average coverage is about $5000.00 per individual, and it will not be extended no matter what. If it does over that set amount, coverage would have to be directed to your general health care plan. Cases with liability only coverage have no Med Pay amount.
Also if you are told you have a $5000.00 limit on Med Pay from your own insurance, do not assume that you have a "blank check" to spend $5000.00 and the insurer will cover it. We have found that they seldom approve the amounts that you are supposed to be guaranteed. They will make their own judgment on what they think they will pay and look for any reason to lower the settlement amount. Only the medical bills will be most likely guaranteed to be paid from any $5000.00 limit.
SETTLEMENT ON MOST "WALK AWAY" CASES
If we refer you to a medical doctor or if you elect to have expensive testing from the medical community, it is better for you to settle your case with us first. You would be better off to first settle with the insurer to meet your personal demands and satisfy your bills. After signing off, all subsequent bills for your health care no longer need to be reimbursed from the auto claim. Your health care would meet these needs and the auto insurer would no longer have to reimburse them since your case is closed. There is no loss to you, and you are more likely to be able to settle on your bill with us and have a reasonable pain and suffering payment. The insurer is only concerned about the settlement amount no matter where the funds are going.
If you had very serious long lasting damage that is MEASURABLE and OBVIOUS to the point of WINNING YOUR CASE IN COURT BY A JURY OF YOUR PEERS, you need an attorney and, more than likely, we would not be the primary care doctor. You will never get a large settlement from the insurer on most all "Walk Away" auto accidents. In all cases, to my knowledge, the chiropractic fees and/or medical fees will far exceed any pain and suffering money that could be expected. Often, it turned out that all the victim received from their "walk away" accident is enough to pay these bills only. Often, the first offers and subsequent settlement offers paid only the medical bills and they did not meet the chiropractic bills leaving nothing for "pain and suffering." Most recently, working directly with an insurer, no matter who, we have found that working only with an attorney who signs either a lien or letter of understanding to pay us directly upon settlement is the only way we will be treated fairly.
Medical doctors fees and procedures are very expensive, and if a claim is made, they will always have to be paid back first from any settlement monies, regardless of your wishes; this means the medical community gets paid before you do and before we get paid. They are paid off the top, and the patient and the chiropractor gets paid from what's left over. This is not a coincidence; it is just another part of the monopolization of care into the hands of the medical community. Always the medical doctors have spent little or no time helping you, and the cost of their procedures will tip the scales on the settlement. This leaves very little resources left for other consideration. This is true whether an attorney is involved or not. We prefer to accept cases where we are the initial primary care physician and if it is not resolving well in accordance to the Plan of Care, we do not want to continue to see you and increase the bill. If you elect to see another physician, you will be asked to settle with us by paying us or by settling the case with the insurer so they can pay us. We expect to see the patient no more than 2-3 months for a reevaluation to make this determination. Any thing less than 1-2 a week is viewed as occasional.
Any more often treatments (20+), the insurer views as excessive. They claim that if a patient does not recover after a certain limited time frame, the patient should be referred out to different treatment or released. It's a conflict that cannot end well.
Please do not start your care with us unless you can agree to this. Remember that your own health insurance will pay for your medical bills when the case is closed. Any health or auto insurer will not pay for care that is unique to generalized chiropractic care codes to established insurers.
We are a physician centered practice where our patients and we see our relationship as a doctor/patient relationship, We cannot see an auto case as anything less important. It is imperative that you understand that an auto case often puts a strain on that special relationship. You want to know how well your health insurance is going to help you with chiropractic services before you get started; it is also important for you to understand how it really works with an auto insurer. Obviously, the smaller the settlement amount, the easier and faster the settlement; we do not to be involved in any auto claim and certainly none that does not reasonably profit this office. Initially, you may well have heard different more encouraging statements from your insurer, but when you have to settle your claims, you will discover what other insurers and providers have learned. It's all business to them. They do not feel compelled to necessarily meet the bills that have accumulated.
Please do not come to us telling us what your auto insurance requests and will do when we have not accepted your case and changed your status in accordance to our terms. We would never make any exception to this if you did not agree to these terms. We stopped accepting auto recovery cases and stopped claims. We would stop any Self Pay care, release the patient, replace any available slots in our schedule, and risk the loss of the patient to avoid having to file claims and file documentation to any auto carrier.
STEPS TO BE FOLLOWED FOR AUTO RECOVERY
1. INTERVIEW WITH A CASE MANAGER.
This may be the entire first visit giving us an opportunity to evaluate the case and review the records provided. We understand that you may be in pain; however, this phase cannot be ignored. Any severe pain (9 or 10 out a scale of 10) may be telling you that you need to go to the emergency room. If you are very uncomfortable, please bring along a significant other, family member, etc. to help you go through this process. Please do not believe that somehow we can get you out of pain in one visit and you can get on with it. This is no different than any patient who sees us who presents in discomfort. We know that you are anxious and concerned. You may even be angry, but remember we are here to help you. Consider for a moment, who else is even willing to help you or even talk with you for some reimbursement that may or may not be forthcoming for another year or two more, other than another chiropractor.
Bring with you the accident report, notes on the details of the accident, photos of the car and any observable injuries, did you go to the hospital, what is said in the hospital report and what was their diagnosis, what was said by you, others, and the police officer after the accident. We need the claim number, claim representative's name, both auto insurance companies and policy numbers. Have you seen an attorney, who is it, and do any of these people know you want to see us, Did you talk with the insurance companies, what did you tell them, and what did they tell you?
Go to Forms for the necessary forms to complete. You will be filling out outcome reports on your injuries, essentially reporting on an established survey accepted in this industry for rating your present condition and limitations, so we can establish a baseline for a plan of care. If you cannot complete these forms showing that you have a problem, there is no point to going any further. You also will be completing a detailed history and a financial agreement form. All of this could take some time during this first visits before we can schedule your examination and our radiographic study. Completing paperwork ahead of time and reading this information on the web before the visit, will be helpful and can save some time.
Critical consideration needs to be established for any smooth and successful resolution: (1) Did the accident report record any injuries, did you say that you hurt, and was there some reasonable speed and acceleration that would make it look this way? (2) How long ago was the accident? (3) Did you go to the hospital and what did they say? (4) Did you call the insurance companies and establish with them that you were hurt and are seeking professional help? (5) Were there observable damages to the car? Was it totalled? What were the repair costs? (6) Did you receive any visible injuries, such as cuts, scrapes, bruising, etc? If so, take pictures. Were they seen by others on the scene?
Also, were you wearing a seat belt? Did it hurt you anywhere in restraint? Where was your head rest position? Is it too low for you? What is your size and weight regarding the size of the seat and cab space? Females are more likely to be hurt in an accident.
Do you have a viable health insurance policy and what is its chiropractic limitations? Have you met your deductible?
One of 4 things will transpire (1) we agree to ACCEPT ASSIGNMENT and will not use your health insurance, (2) we refuse to take the case on ASSIGNMENT, but will treat you under your chiropractic health care, (3) we cannot take the case at all, (4) we agree to ACCEPT ASSIGNMENT under certain conditions, to possibly include, a sum of money put into a special account, loan papers put forth to establish a more formal loan relationship, and/or you must get an attorney and he/she must present to our office lien papers guaranteeing monies to be paid directly to us upon completion of the case.
NEED FOR AN ATTORNEY
The case manager will recommend whether or not we believe that an attorney is needed. From our experience, we have not noticed any difference in the settling of a case with or without an attorney. This is because most all cases do not go to court. Court is expensive for everyone, and without measurable damages no one is going to do it. I have seen attorneys go for a court date showing their client's resolve and then have a more agreeable settlement come forth when nothing else was working. Bottom line, no one can truly fight for you, if you are not willing to fight for a favorable resolution; if the insurance company knows this in any fashion, they have the upper hand and will not move on a settlement figure.
In most cases now, we can no longer rely upon the resolve of others to consider our interests also. We are always busy and scheduled, so by seeing patients on these conditions has proven to be a bad investment.
Your insurance will only pay out your Med Pay, and no more. This is often gone after one hospital visit, some hospital priced imaging and an expensive ambulance ride. Most people do not even know what their Med Pay limitation is on their insurance policy.
For any more, someone has to fight for it; and we are not allowed into this process other than providing a bill and documentation to support the need for care. To be considered regarding attorneys: (1) You do not want to deal with this directly so you are willing to hire them to deal with it for you, (2) There is conflict regarding who is at fault, (3) Measurably serious life threatening injuries were sustained establishing you as an in-patient with potentially a disabling condition, (4) You have neurological complaints following an injury, to include persistent headaches that were not experienced prior to the accident, dizziness, nausea, loss of consciousness. We have found that in all cases with attorneys it takes much longer to settle the case with no better financial resolution for the client or the providers. We have some attorneys with whom we have had good experiences and some with bad; we do not share this information.
Some attorneys try to create more money for themselves and you by negotiating down the provider fees when the settlement fee is not so good, and they know it is not a good case for them to go to court with. Our priority is to improve the condition of all patients and to be paid fairly for our time and the procedures performed, so we naturally resent this "fee manipulation" when we have to wait so long for payment. We did not "pad" the fee to account for some attorney to try and reduce it. This occurs in "no fault" states all the time.
BILL OF SERVICES RECEIVED
1. INTERVIEW WITH A CASE MANAGER.
This may be the entire first visit giving us an opportunity to evaluate the case and review the records provided. We understand that you may be in pain; however, this phase cannot be ignored. Any severe pain (9 or 10 out a scale of 10) may be telling you that you need to go to the emergency room. If you are very uncomfortable, please bring along a significant other, family member, etc. to help you go through this process. Please do not believe that somehow we can get you out of pain in one visit and you can get on with it. This is no different than any patient who sees us who presents in discomfort. We know that you are anxious and concerned. You may even be angry, but remember we are here to help you. Consider for a moment, who else is even willing to help you or even talk with you for some reimbursement that may or may not be forthcoming for another year or two more, other than another chiropractor.
Bring with you the accident report, notes on the details of the accident, photos of the car and any observable injuries, did you go to the hospital, what is said in the hospital report and what was their diagnosis, what was said by you, others, and the police officer after the accident. We need the claim number, claim representative's name, both auto insurance companies and policy numbers. Have you seen an attorney, who is it, and do any of these people know you want to see us, Did you talk with the insurance companies, what did you tell them, and what did they tell you?
Go to Forms for the necessary forms to complete. You will be filling out outcome reports on your injuries, essentially reporting on an established survey accepted in this industry for rating your present condition and limitations, so we can establish a baseline for a plan of care. If you cannot complete these forms showing that you have a problem, there is no point to going any further. You also will be completing a detailed history and a financial agreement form. All of this could take some time during this first visits before we can schedule your examination and our radiographic study. Completing paperwork ahead of time and reading this information on the web before the visit, will be helpful and can save some time.
Critical consideration needs to be established for any smooth and successful resolution: (1) Did the accident report record any injuries, did you say that you hurt, and was there some reasonable speed and acceleration that would make it look this way? (2) How long ago was the accident? (3) Did you go to the hospital and what did they say? (4) Did you call the insurance companies and establish with them that you were hurt and are seeking professional help? (5) Were there observable damages to the car? Was it totalled? What were the repair costs? (6) Did you receive any visible injuries, such as cuts, scrapes, bruising, etc? If so, take pictures. Were they seen by others on the scene?
Also, were you wearing a seat belt? Did it hurt you anywhere in restraint? Where was your head rest position? Is it too low for you? What is your size and weight regarding the size of the seat and cab space? Females are more likely to be hurt in an accident.
Do you have a viable health insurance policy and what is its chiropractic limitations? Have you met your deductible?
One of 4 things will transpire (1) we agree to ACCEPT ASSIGNMENT and will not use your health insurance, (2) we refuse to take the case on ASSIGNMENT, but will treat you under your chiropractic health care, (3) we cannot take the case at all, (4) we agree to ACCEPT ASSIGNMENT under certain conditions, to possibly include, a sum of money put into a special account, loan papers put forth to establish a more formal loan relationship, and/or you must get an attorney and he/she must present to our office lien papers guaranteeing monies to be paid directly to us upon completion of the case.
NEED FOR AN ATTORNEY
The case manager will recommend whether or not we believe that an attorney is needed. From our experience, we have not noticed any difference in the settling of a case with or without an attorney. This is because most all cases do not go to court. Court is expensive for everyone, and without measurable damages no one is going to do it. I have seen attorneys go for a court date showing their client's resolve and then have a more agreeable settlement come forth when nothing else was working. Bottom line, no one can truly fight for you, if you are not willing to fight for a favorable resolution; if the insurance company knows this in any fashion, they have the upper hand and will not move on a settlement figure.
In most cases now, we can no longer rely upon the resolve of others to consider our interests also. We are always busy and scheduled, so by seeing patients on these conditions has proven to be a bad investment.
Your insurance will only pay out your Med Pay, and no more. This is often gone after one hospital visit, some hospital priced imaging and an expensive ambulance ride. Most people do not even know what their Med Pay limitation is on their insurance policy.
For any more, someone has to fight for it; and we are not allowed into this process other than providing a bill and documentation to support the need for care. To be considered regarding attorneys: (1) You do not want to deal with this directly so you are willing to hire them to deal with it for you, (2) There is conflict regarding who is at fault, (3) Measurably serious life threatening injuries were sustained establishing you as an in-patient with potentially a disabling condition, (4) You have neurological complaints following an injury, to include persistent headaches that were not experienced prior to the accident, dizziness, nausea, loss of consciousness. We have found that in all cases with attorneys it takes much longer to settle the case with no better financial resolution for the client or the providers. We have some attorneys with whom we have had good experiences and some with bad; we do not share this information.
Some attorneys try to create more money for themselves and you by negotiating down the provider fees when the settlement fee is not so good, and they know it is not a good case for them to go to court with. Our priority is to improve the condition of all patients and to be paid fairly for our time and the procedures performed, so we naturally resent this "fee manipulation" when we have to wait so long for payment. We did not "pad" the fee to account for some attorney to try and reduce it. This occurs in "no fault" states all the time.
BILL OF SERVICES RECEIVED
Our bills for each procedure in an auto case are no different than our pre-established fees on record that are used in the claims on our daily health care cases to Blue Cross. They have not increased in over ten years. By contract, only Blue Cross can reduce our retail fees to conform to their schedule. All required procedural and diagnostic codes must be authorized by a certified doctor and the fees must conform to all fees sent to any insurer. No discounted fees can be involved. One may have been receiving past care for a discounted fee of $50 exchanged on the day of service, but when any insurance is used we must conform to our posted retail fees which total a combined procedural cost of $150-$200 per visit. The total bill sent to your attorney can be as high as $4000-$5000 depending on the total visitations. Remember, we all may have to wait as long as two years to collect this amount. Anything paid to us short of this amount by you is considered a required good faith payment, as well as, only a partial payment with a balance owed by you..
When you add up all of costs evolved given their dragged out time frame, you also can understand the insurer's concerns. Consider auto repair costs, ambulance, medical outpatient and imaging, chiropractic care and imaging, pain and suffering, paperwork and documentation, collection costs, any additional medical and chiropractic fees, and attorney fees; the total is staggering nationwide.
None of the doctors have the time to do these extra costs but each must employ staff within the institution to prepare documentation and inquire into the progress of a case. We are only a small private single doctor office. We have only a small part time staff. These larger facilities have many doctors or many attorneys who are designed to have larger full time support staffs dealing in collections, finances, claims, documentation, and records.
ATTORNEYS
After reading this, you may see that it is good idea to have an attorney. Even so, attorneys are not doing a lot of work, but rather they are doing a lot of waiting as their clerks are organizing a lot of paperwork. Few ever go to court, but from our viewpoint we are more likely to get paid eventually if an attorney is used. We have no business relationship with any attorney, as we see this as a conflict of interests. We can provide a small list of attorneys in the area for you to consider. No attorney should be telling you who should be providing you care, and if you are receiving care, they should not be negatively influencing that doctor/patient relationship.
MEDICAL CARE
Most often statistically, chiropractors see patients having less serious injuries from auto cases. The most serious injuries go to the hospitals and seldom end up seeing chiropractors. Life threatening injuries seldom see chiropractors.
For less serious complications from auto collisions, medical doctors do very little to help the complaint, unless by giving medications, oral or injection, and by sending them to a physical therapist, if one considers these as help. The medical doctor will spend very little time with the patient, and will not perform any hands on treatment. Their treatment is not a process, and they are a referral care system that manages and documents.
Their purpose is for life supporting treatments, and for providing tests. They provide more documentation and can become another professional who is witness to your complaints. Some attorneys like to use a medical doctor as they feel it more greatly validates your condition. Seldom, however, unless the injuries are great, can the medical doctor state definitively that the collision caused the problem, because they have no pretest from which to determine a "cause and effect" relationship..
Because their testing is done outside their private offices and by a separate parties with an outside radiographic opinion , the costs are greater. Their static images do not include any consideration for postural analysis, weight bearing influences, and dynamic positions; therefore, real stability and associated neurological problems can go undiagnosed, even on MRI images. As you can see, any extra costs can only make financial settlements more difficult.
However, in all cases where the injured party expects a large financial settlement and to win a court case for large pain and suffering monies, medical confirmation is needed. Remember, however, that their documents must confirm measurable damages caused by the accident. Sometimes the medical community cannot show a causal relationship.
CARRIERS HAVE PRE CONCEIVED BELIEFS
Agents are given false information and limited data. They are rewarded by staying in budget and by saving the company money. No matter how nice they seem to be, they are not your friend. Always refer them to your attorney or to your physician for answers to their questions. They always want you to settle early by design.
THEIR UNSPOKEN BELIEFS REGARDING WALK AWAY AUTO CLAIMS
1. MOST PROVIDERS WHO SEEK AND TREAT AUTO CASES ARE CHEATERS.
2. MOST WALK AWAY INJURIES ARE EXAGGERATED.
3. ONLY MEDICAL OPINIONS ARE VALID.
4. MOST PEOPLE DO NOT FILE FOR WALK AWAY CLAIMS, SO WHAT'S WITH YOU.
5.MOST LIFE THREATENING INJURIES HAVE NO CHIROPRACTIC CLAIMS SO WHY WOULD YOU?
6. ANY REDUCTION IN SETTLEMENT FEES MULTIPLED BY 10'S OF THOUSANDS OF ACCIDENTS LEAVES MORE MONEY FOR REALLY IMPORTANT "BIG DOLLAR" CASES.
7. OTHER CLIENTS WITH SIMILAR COLLISION FACTORS, MADE NO CLAIMS.
8. ONLY SERIOUS HIGH SPEEDS WITH SERIOUS DAMAGE TO THE VEHICLE CAN PRODUCE PHYSICAL INJURIES.
9. AUTOS ARE SAFER NOW, SO WHY THE COMPLAINTS.
10. PATIENTS ARE RECEIVING TOO MUCH CARE AND WANT FREE CARE.
11. THIS WAS A PAST INJURY. THEY HAVE SEEN A CHIROPRACTIC BEFORE SO IT IS A PREEXISTING CONDITION.
12. ONLY THE CERVICAL SPINE CAN BE HURT SO WE DO NOT NEED ANY CARE FOR THE THORACIC AND LUMBAR REGIONS.
2. RADIOGRAPHIC STUDY AND REPORT OF FINDINGS
You will have a full set of radiographs taken in our office. You will be given a chiropractic and orthopedic examination of greater scope than most of our examinations or more so than was given you in most ERs or from medical facilities.
Dr. Crafton will analyze the images and report to you on her findings following the examination. Written reports will be prepared and placed into the files. You will be given a separate file for your auto case. You will be required to complete each visit Subjective portion of the daily notes.
Dr. Crafton will present you with a Report of Findings as she reviews the radiographs findings. This oral report may have to be put into a written report as documentation. The report will determine a Plan of Care. The Plan of Care will include the treatment, adjustments and therapies to be performed, the number of expected visits and their frequency, and an estimated length of time before we re-evaluate your case. You will be asked to agree to this Plan of Care and you will be scheduled in advance for your care following the first treatment session. See definition of Plan of Care under Medicare to understand compliance and on how well the physician would believe you are following this plan. This has to be objectively reported to the insurer.
As stated earlier, medical doctors seldom see a patient for monies to be received from a later settlement. They are guaranteed payment without these limitations, so fees are high and the care is very time restricted and spread out over greater time periods.
3. UPON COMPLETION OF THE PLAN OF CARE
A reevaluation will be performed. This is an examination and possibly another set of radiographs will be analyzed. Outcomes surveys may be completed to establish your present condition and limitations.
Dr. Crafton will talk with you regarding your progress. One of three things will happen: (1) You will be released. You will report this to the insurance company or to your attorney. This means that according to the physician, you have met your Maximum Medical Benefit (MMB). There are no established definitions as to what this means, but it seems to mean that we do not believe that we can help you any more. As much as possible in a concentrated plan of care, you have been brought to your status prior to the accident. As you can see, any definition of MMB is conditional and is designed to limit care on to what they consider is their responsibility as an insurer. They consider it is a successful resolution of the case; it does not mean that you are perfect or even pleased. Insurance does not believe that they are obligated for any more investment into your care. By agreement in accepting assignment with us, if we say that MMB is reached, you must settle and sign off on your case, or your loan is due. If you have agreed to signed off, we reasonably provide documents and wait for payment, (2) We decide to continue your treatment with any necessary modifications for a set period of time. The insurance company and/or attorney are informed of the extension. (3) Maybe you did not follow the plan well. We could modify the plan or we could dismiss you and require payment, (4) We could say that you have met MMB but you disagree, meaning that you seek other care and settle with us financially, (5) if you do not have an attorney, you may want to get one if you do not feel that you are getting better and you are resolved to go to court to fight for more care. Payment is still expected because we have provided the bills and documents for settlement and now are out of the picture, and a collection process will be set forth. Cases like these can take years to settle, and never reward the provider for their long wait and often end badly for everyone.
4. SIGN THE RELEASE FORMS AND SIGN AN AGREEMENT TO CLOSE THE CASE
Make sure that you agree to enough money to pay for your bill. Make sure that the insurance company sets aside in a separate check the money to pay for each caregiver you have used. We have agreed upon a set of circumstances, where we require a separate check paid in full for our services. Anything else is your business; but remember, if it is such a serious case, it has to be reflected in the services your received. What we are paid has nothing to do with what you expect to receive; actually, the more services you require, the more "Pain and Suffering" is justifiable. If you have inconsistent visits with long periods of receiving no care, you have a bad case for any resolution requiring more compensation; also, it makes it more difficult for the next person needing care and having to get fair compensation. You are viewed as "noncompliant" to the established plan.
All reports and documentation are considered part of the settlement fee as long as we are considered the primary physician. A narrative report is a term used in the industry to refer to a very detailed report which includes research, photos, and studies that essentially represent the case as it would go to court. This requires an extra cost by you or your attorney of several thousands. A complete Narrative report is expensive and is to be done by the physician. A summary report is not a narrative report; one page report is not a narrative report. A summary one page report is much less expensive, but it is beyond not just providing the standard documentation required for settlement. We do not go through the cost of doing a Narrative Report unless it is required by the attorney. It would be considered their cost of doing business because it is the basis for their presentation of the case. If anything, it is to be understood that the physician is the witness to the legitimacy of the case. They need to be objective and it is their opinion that makes the case for any claims of personal damage.
Rarely, insurance has paid for chiropractic natural supplementation for inflammation and pain. They have in the past paid for neck supports and braces. They have occasionally paid for home use active equipment and pain relief, such as TENS units for pain distraction and muscle relaxation and the Posture Pump or Pro Neck cervical devices for Continuous Passive Motion and traction. Most recently, however, they refuse any additional supplementary care other than manipulation, imaging, and therapy codes. Now we refuse to increase the overall cost, but may offer these on a more cash friendly basis.
OVERVIEW
It has been our experience that people who hurt make their appointments, and too many patients do not want to spend the time necessary to stabilize and strengthen their vulnerable conditions. Patients who must travel far for care are seldom compliant. When they think they are better, they do not come as often, but this does not necessarily help the validity of their case. It seems absurd that insurance views attending too often as something that people are taking advantage of. It's harder work to see a chiropractor; you must show up and you are being asked to make changes and perform additional activities. Medical doctors seldom make these demands on you. Here we seem to get the victim better faster; therefore, it is less costly. We should be seeing patients longer to stabilize them, but it is less common in practical application because too many patients just do not have the resources.
In almost all our cases, the accident aggravated the condition. The accident did not initially cause the condition. The patient was vulnerable and had a unknown non-symptomatic condition aggravated to some degree by accelerated forces bringing about pain, headaches, and limiting functions.
MYTHS ABOUT SMALLER INJURIES
What most people believe to be low forces can cause very serious problems. Experts in the business of auto recovery call a 10 mph collision, high speed. When the victim retells the events, they will almost always think the acceleration is greater than the actual speed. In these collisions, you can injure your mid and lower back and not just your neck. Soft tissue injuries are not to be discounted; nervous and ligamentum tissue are soft and if traumatized to some degree can destroy the future quality of your life and can too easily go undiagnosed. But if you cannot prove your point, it goes untreated, undiagnosed, and worsens with age. There is always a history and often previous arthritic conditions from earlier injuries determine the scope and degree of influence on the condition.
You are entitled to care but it is not a situation where everything that was not right, is now going to made right for you. Seldom is it enough in itself to qualify you for disability or give you tens of thousands in new found funds. It has never been enough for people to want to go out there and get hit. Smaller claims settle in their entity on the average for a few thousand dollars. Chiropractors who base their practice on auto claims must make much more, and so they do per claim, but most work in "no fault" states. Their business model is entirely different than ours.
Accidents can be terrible, messy, and life threatening, but chiropractors do not see these cases. The patient's life may be saved by life support and surgery, but no one is looking at the joint injuries that certainly were sustained, because they are not addressed. Everyone feels successful to be alive. These serious injuries will have a negative effect on their health forever with joint problems being just one area. We see more cases where these joint injuries are the most important "walk away" complaint. They commonly produce neck pain, headaches, some low back pain, and shoulder pain. Younger people resolve negative symptoms faster than older people. Females are hurt more than men. If you did not see it coming, you are likely to be hurt to a greater degree. If you injured nervous tissue, it takes a long time to heal. The common medical standard for healing is 90 days when there is no further aggravation. Obviously, it is aggravated by your lifestyle and work environment; it is also hurt by inflammatory drugs which stop the healing process. People still work with neck pain and headaches; they do not go to work with severe low back problems. Your cases should resolve well and if you can, you can work and be reasonably active, but consider yourself during your plan of care to be disabled with limitations OR WHY IS IT THAT YOU FILED A CLAIM? No one is going to follow you around in a smaller claim, to see if you are malingering, but they will if you go to court or file a complaint with the State of Alabama. If it is going to cost them, they will find the funds to get any information to save money.
Another myth exists about care to be received from any physician, especially chiropractors. Somehow physicians do not need to be paid unless it works out well for the patient, either by how they feel or by the settlement. Somehow, there was some implied contract that if the chiropractor did not get paid enough by the insurance, the patient is not responsible for the bill. This is not the case, nor is it reasonable. Do you assume that the chiropractor was so friendly and nice that they will take less money or not expect payment if it does not work out well for you in your settlement. All providers are going to demand payment regardless of whether you get better or not, or whether you are satisfied with the extent of your recovery. They need to be equably treating all patients fairly. They cannot operate a system that ignores debt for some and still stay in business. No case is taken with any understanding that if the insurance does not pay the physician fairly, the patient is not obligated. As with all debt, cases can go through a reasonably negotiated settlement of an amount mutually agreed to resolve the debt.
UPON RELEASE
All providers are going to bill and follow up with collections after a reasonable period has elapsed. Their payment is for the procedures performed on certain dates for a set amount. If the carrier (insurer) must have to deal with a claim, they like to see a case where you test and present poorly, show up for the established plan of care visits, the paperwork is familiar and prompt, and that you are satisfied, test and present much better, and, of course, sign off for a figure that they pre-established when they first heard about the accident.
There are only two ways to fight to get what you believe you need. You have to be willing to go to court and/or you must be willing to file a complaint with the State of Alabama Insurance Commission. In each case, it is not up to the attorney or the physician, it's up to you. You can be in a process of fighting for what you believe is right; however, if your bills are not being paid, all physicians will be demanding payment, expecting you to pay yourself back if it settles in your favor. Even attorneys will be pressing for monies, if from their experience, they feel that a favorable outcome is too costly or is not going to happen, but you still want to press onwards, anyways.
In most all cases, we will not accept assignment unless the patient has been a long term patients or the patient has BCBS insurance with deductibles met and existing limitations necessary to meet a reasonable plan of care. We will file with only the BCBS health insurance near or upon the dates of service and you be may asked to pay the coinsurance.
When you add up all of costs evolved given their dragged out time frame, you also can understand the insurer's concerns. Consider auto repair costs, ambulance, medical outpatient and imaging, chiropractic care and imaging, pain and suffering, paperwork and documentation, collection costs, any additional medical and chiropractic fees, and attorney fees; the total is staggering nationwide.
None of the doctors have the time to do these extra costs but each must employ staff within the institution to prepare documentation and inquire into the progress of a case. We are only a small private single doctor office. We have only a small part time staff. These larger facilities have many doctors or many attorneys who are designed to have larger full time support staffs dealing in collections, finances, claims, documentation, and records.
ATTORNEYS
After reading this, you may see that it is good idea to have an attorney. Even so, attorneys are not doing a lot of work, but rather they are doing a lot of waiting as their clerks are organizing a lot of paperwork. Few ever go to court, but from our viewpoint we are more likely to get paid eventually if an attorney is used. We have no business relationship with any attorney, as we see this as a conflict of interests. We can provide a small list of attorneys in the area for you to consider. No attorney should be telling you who should be providing you care, and if you are receiving care, they should not be negatively influencing that doctor/patient relationship.
MEDICAL CARE
Most often statistically, chiropractors see patients having less serious injuries from auto cases. The most serious injuries go to the hospitals and seldom end up seeing chiropractors. Life threatening injuries seldom see chiropractors.
For less serious complications from auto collisions, medical doctors do very little to help the complaint, unless by giving medications, oral or injection, and by sending them to a physical therapist, if one considers these as help. The medical doctor will spend very little time with the patient, and will not perform any hands on treatment. Their treatment is not a process, and they are a referral care system that manages and documents.
Their purpose is for life supporting treatments, and for providing tests. They provide more documentation and can become another professional who is witness to your complaints. Some attorneys like to use a medical doctor as they feel it more greatly validates your condition. Seldom, however, unless the injuries are great, can the medical doctor state definitively that the collision caused the problem, because they have no pretest from which to determine a "cause and effect" relationship..
Because their testing is done outside their private offices and by a separate parties with an outside radiographic opinion , the costs are greater. Their static images do not include any consideration for postural analysis, weight bearing influences, and dynamic positions; therefore, real stability and associated neurological problems can go undiagnosed, even on MRI images. As you can see, any extra costs can only make financial settlements more difficult.
However, in all cases where the injured party expects a large financial settlement and to win a court case for large pain and suffering monies, medical confirmation is needed. Remember, however, that their documents must confirm measurable damages caused by the accident. Sometimes the medical community cannot show a causal relationship.
CARRIERS HAVE PRE CONCEIVED BELIEFS
Agents are given false information and limited data. They are rewarded by staying in budget and by saving the company money. No matter how nice they seem to be, they are not your friend. Always refer them to your attorney or to your physician for answers to their questions. They always want you to settle early by design.
THEIR UNSPOKEN BELIEFS REGARDING WALK AWAY AUTO CLAIMS
1. MOST PROVIDERS WHO SEEK AND TREAT AUTO CASES ARE CHEATERS.
2. MOST WALK AWAY INJURIES ARE EXAGGERATED.
3. ONLY MEDICAL OPINIONS ARE VALID.
4. MOST PEOPLE DO NOT FILE FOR WALK AWAY CLAIMS, SO WHAT'S WITH YOU.
5.MOST LIFE THREATENING INJURIES HAVE NO CHIROPRACTIC CLAIMS SO WHY WOULD YOU?
6. ANY REDUCTION IN SETTLEMENT FEES MULTIPLED BY 10'S OF THOUSANDS OF ACCIDENTS LEAVES MORE MONEY FOR REALLY IMPORTANT "BIG DOLLAR" CASES.
7. OTHER CLIENTS WITH SIMILAR COLLISION FACTORS, MADE NO CLAIMS.
8. ONLY SERIOUS HIGH SPEEDS WITH SERIOUS DAMAGE TO THE VEHICLE CAN PRODUCE PHYSICAL INJURIES.
9. AUTOS ARE SAFER NOW, SO WHY THE COMPLAINTS.
10. PATIENTS ARE RECEIVING TOO MUCH CARE AND WANT FREE CARE.
11. THIS WAS A PAST INJURY. THEY HAVE SEEN A CHIROPRACTIC BEFORE SO IT IS A PREEXISTING CONDITION.
12. ONLY THE CERVICAL SPINE CAN BE HURT SO WE DO NOT NEED ANY CARE FOR THE THORACIC AND LUMBAR REGIONS.
2. RADIOGRAPHIC STUDY AND REPORT OF FINDINGS
You will have a full set of radiographs taken in our office. You will be given a chiropractic and orthopedic examination of greater scope than most of our examinations or more so than was given you in most ERs or from medical facilities.
Dr. Crafton will analyze the images and report to you on her findings following the examination. Written reports will be prepared and placed into the files. You will be given a separate file for your auto case. You will be required to complete each visit Subjective portion of the daily notes.
Dr. Crafton will present you with a Report of Findings as she reviews the radiographs findings. This oral report may have to be put into a written report as documentation. The report will determine a Plan of Care. The Plan of Care will include the treatment, adjustments and therapies to be performed, the number of expected visits and their frequency, and an estimated length of time before we re-evaluate your case. You will be asked to agree to this Plan of Care and you will be scheduled in advance for your care following the first treatment session. See definition of Plan of Care under Medicare to understand compliance and on how well the physician would believe you are following this plan. This has to be objectively reported to the insurer.
As stated earlier, medical doctors seldom see a patient for monies to be received from a later settlement. They are guaranteed payment without these limitations, so fees are high and the care is very time restricted and spread out over greater time periods.
3. UPON COMPLETION OF THE PLAN OF CARE
A reevaluation will be performed. This is an examination and possibly another set of radiographs will be analyzed. Outcomes surveys may be completed to establish your present condition and limitations.
Dr. Crafton will talk with you regarding your progress. One of three things will happen: (1) You will be released. You will report this to the insurance company or to your attorney. This means that according to the physician, you have met your Maximum Medical Benefit (MMB). There are no established definitions as to what this means, but it seems to mean that we do not believe that we can help you any more. As much as possible in a concentrated plan of care, you have been brought to your status prior to the accident. As you can see, any definition of MMB is conditional and is designed to limit care on to what they consider is their responsibility as an insurer. They consider it is a successful resolution of the case; it does not mean that you are perfect or even pleased. Insurance does not believe that they are obligated for any more investment into your care. By agreement in accepting assignment with us, if we say that MMB is reached, you must settle and sign off on your case, or your loan is due. If you have agreed to signed off, we reasonably provide documents and wait for payment, (2) We decide to continue your treatment with any necessary modifications for a set period of time. The insurance company and/or attorney are informed of the extension. (3) Maybe you did not follow the plan well. We could modify the plan or we could dismiss you and require payment, (4) We could say that you have met MMB but you disagree, meaning that you seek other care and settle with us financially, (5) if you do not have an attorney, you may want to get one if you do not feel that you are getting better and you are resolved to go to court to fight for more care. Payment is still expected because we have provided the bills and documents for settlement and now are out of the picture, and a collection process will be set forth. Cases like these can take years to settle, and never reward the provider for their long wait and often end badly for everyone.
4. SIGN THE RELEASE FORMS AND SIGN AN AGREEMENT TO CLOSE THE CASE
Make sure that you agree to enough money to pay for your bill. Make sure that the insurance company sets aside in a separate check the money to pay for each caregiver you have used. We have agreed upon a set of circumstances, where we require a separate check paid in full for our services. Anything else is your business; but remember, if it is such a serious case, it has to be reflected in the services your received. What we are paid has nothing to do with what you expect to receive; actually, the more services you require, the more "Pain and Suffering" is justifiable. If you have inconsistent visits with long periods of receiving no care, you have a bad case for any resolution requiring more compensation; also, it makes it more difficult for the next person needing care and having to get fair compensation. You are viewed as "noncompliant" to the established plan.
All reports and documentation are considered part of the settlement fee as long as we are considered the primary physician. A narrative report is a term used in the industry to refer to a very detailed report which includes research, photos, and studies that essentially represent the case as it would go to court. This requires an extra cost by you or your attorney of several thousands. A complete Narrative report is expensive and is to be done by the physician. A summary report is not a narrative report; one page report is not a narrative report. A summary one page report is much less expensive, but it is beyond not just providing the standard documentation required for settlement. We do not go through the cost of doing a Narrative Report unless it is required by the attorney. It would be considered their cost of doing business because it is the basis for their presentation of the case. If anything, it is to be understood that the physician is the witness to the legitimacy of the case. They need to be objective and it is their opinion that makes the case for any claims of personal damage.
Rarely, insurance has paid for chiropractic natural supplementation for inflammation and pain. They have in the past paid for neck supports and braces. They have occasionally paid for home use active equipment and pain relief, such as TENS units for pain distraction and muscle relaxation and the Posture Pump or Pro Neck cervical devices for Continuous Passive Motion and traction. Most recently, however, they refuse any additional supplementary care other than manipulation, imaging, and therapy codes. Now we refuse to increase the overall cost, but may offer these on a more cash friendly basis.
OVERVIEW
It has been our experience that people who hurt make their appointments, and too many patients do not want to spend the time necessary to stabilize and strengthen their vulnerable conditions. Patients who must travel far for care are seldom compliant. When they think they are better, they do not come as often, but this does not necessarily help the validity of their case. It seems absurd that insurance views attending too often as something that people are taking advantage of. It's harder work to see a chiropractor; you must show up and you are being asked to make changes and perform additional activities. Medical doctors seldom make these demands on you. Here we seem to get the victim better faster; therefore, it is less costly. We should be seeing patients longer to stabilize them, but it is less common in practical application because too many patients just do not have the resources.
In almost all our cases, the accident aggravated the condition. The accident did not initially cause the condition. The patient was vulnerable and had a unknown non-symptomatic condition aggravated to some degree by accelerated forces bringing about pain, headaches, and limiting functions.
MYTHS ABOUT SMALLER INJURIES
What most people believe to be low forces can cause very serious problems. Experts in the business of auto recovery call a 10 mph collision, high speed. When the victim retells the events, they will almost always think the acceleration is greater than the actual speed. In these collisions, you can injure your mid and lower back and not just your neck. Soft tissue injuries are not to be discounted; nervous and ligamentum tissue are soft and if traumatized to some degree can destroy the future quality of your life and can too easily go undiagnosed. But if you cannot prove your point, it goes untreated, undiagnosed, and worsens with age. There is always a history and often previous arthritic conditions from earlier injuries determine the scope and degree of influence on the condition.
You are entitled to care but it is not a situation where everything that was not right, is now going to made right for you. Seldom is it enough in itself to qualify you for disability or give you tens of thousands in new found funds. It has never been enough for people to want to go out there and get hit. Smaller claims settle in their entity on the average for a few thousand dollars. Chiropractors who base their practice on auto claims must make much more, and so they do per claim, but most work in "no fault" states. Their business model is entirely different than ours.
Accidents can be terrible, messy, and life threatening, but chiropractors do not see these cases. The patient's life may be saved by life support and surgery, but no one is looking at the joint injuries that certainly were sustained, because they are not addressed. Everyone feels successful to be alive. These serious injuries will have a negative effect on their health forever with joint problems being just one area. We see more cases where these joint injuries are the most important "walk away" complaint. They commonly produce neck pain, headaches, some low back pain, and shoulder pain. Younger people resolve negative symptoms faster than older people. Females are hurt more than men. If you did not see it coming, you are likely to be hurt to a greater degree. If you injured nervous tissue, it takes a long time to heal. The common medical standard for healing is 90 days when there is no further aggravation. Obviously, it is aggravated by your lifestyle and work environment; it is also hurt by inflammatory drugs which stop the healing process. People still work with neck pain and headaches; they do not go to work with severe low back problems. Your cases should resolve well and if you can, you can work and be reasonably active, but consider yourself during your plan of care to be disabled with limitations OR WHY IS IT THAT YOU FILED A CLAIM? No one is going to follow you around in a smaller claim, to see if you are malingering, but they will if you go to court or file a complaint with the State of Alabama. If it is going to cost them, they will find the funds to get any information to save money.
Another myth exists about care to be received from any physician, especially chiropractors. Somehow physicians do not need to be paid unless it works out well for the patient, either by how they feel or by the settlement. Somehow, there was some implied contract that if the chiropractor did not get paid enough by the insurance, the patient is not responsible for the bill. This is not the case, nor is it reasonable. Do you assume that the chiropractor was so friendly and nice that they will take less money or not expect payment if it does not work out well for you in your settlement. All providers are going to demand payment regardless of whether you get better or not, or whether you are satisfied with the extent of your recovery. They need to be equably treating all patients fairly. They cannot operate a system that ignores debt for some and still stay in business. No case is taken with any understanding that if the insurance does not pay the physician fairly, the patient is not obligated. As with all debt, cases can go through a reasonably negotiated settlement of an amount mutually agreed to resolve the debt.
UPON RELEASE
All providers are going to bill and follow up with collections after a reasonable period has elapsed. Their payment is for the procedures performed on certain dates for a set amount. If the carrier (insurer) must have to deal with a claim, they like to see a case where you test and present poorly, show up for the established plan of care visits, the paperwork is familiar and prompt, and that you are satisfied, test and present much better, and, of course, sign off for a figure that they pre-established when they first heard about the accident.
There are only two ways to fight to get what you believe you need. You have to be willing to go to court and/or you must be willing to file a complaint with the State of Alabama Insurance Commission. In each case, it is not up to the attorney or the physician, it's up to you. You can be in a process of fighting for what you believe is right; however, if your bills are not being paid, all physicians will be demanding payment, expecting you to pay yourself back if it settles in your favor. Even attorneys will be pressing for monies, if from their experience, they feel that a favorable outcome is too costly or is not going to happen, but you still want to press onwards, anyways.
In most all cases, we will not accept assignment unless the patient has been a long term patients or the patient has BCBS insurance with deductibles met and existing limitations necessary to meet a reasonable plan of care. We will file with only the BCBS health insurance near or upon the dates of service and you be may asked to pay the coinsurance.