PI Email Alert - Avoid "Dual Fee Schedule" - Push Back 3rd P Fee Cuts

Monday, March 15, 2021

Avoid the Trap

"Dual Fee Schedule?"

Some insurance companies or patients can get really angry if they think you are overcharging for their PI doctor fees.

If a long-time patient reviewed your PI bill, they would be shocked to find out that the cost for the PI case visits are much higher than maintenance care visits.

Some insurers will call your office asking how much you charge for adjustments.

We argue that PI cases are far more involved than non-trauma cases. More work and time is required to stabilize the patient. This should be reflected in your billing detail.

Dr. Gary Lewkovich, DC takes on this issue directly.

The CA Business and Professions Code § 657 permits health care providers to grant fee reductions for prompt payment.

For a copy of Gary’s explanation contact johntawlian@shawnsteel.com.

Push Back Against 3rd Party Fee Cuts

When Mitchell NHQ contacted Dr. Bill in the low desert, they offered to pay him “quickly” If he took a substantial fee cut.

The Document is labeled: “Negotiation of Auto Charges for NHQ bill XXXX”

Dr. Bill wrote back this…” He was paid 100%”

That’s how you do it.

Allstate Charged With Fraud -- Hit With BIG Verdict

Chiropractic patient Michael was driving eastbound on Pico Blvd. in Los Angeles when he was rear-ended by a white SUV. The SUV took off and fled the scene. Michael filed an Uninsured Motorist claim against his insurance company, Allstate.

Allstate claimed that Michael was making a fraudulent claim. Allstate argued in arbitration that Michael had a similar claim in 2016 and since raised his med pay from $5,000 to $25,000. Allstate stated Michael raised his Med Pay to commit fraud. Allstate also claimed that Michael’s injuries were pre-existing.

Michael took the case to formal arbitration and the arbitrator awarded $159,508 against Allstate.

Michael vs. Allstate Uninsured Motorist

May 26, 2020

Practice Tips

It’s frightening when an insurer claims your patient is making a fraudulent claim.
The penalties are staggering and will impact your practice.
Allstate went rogue and paid a big price.
First, do you trust your patient?
Will the PI attorney fight all the way?
Otherwise, don’t be surprised if the attorney drops the case and sticks you with a big unpaid bill.