If you do any PI work in your chiropractic practice, it’s likely your patients have (or will) receive a letter from personal injury payers that can have several potentially disastrous effects on your patient’s care, your claims and, ultimately, the reimbursements you receive for your hard work.

We’ve been getting more frequent reports from frustrated chiropractors whose patients have exhibited some sudden and bizarre symptoms for no apparent reason. Yet, through a little old-fashioned investigating, it turns out that many of these patients all have one thing in common: they each received “the letter” from their car insurance carrier who has handling their claim.

One of the biggest challenges with “the letter” is that you (their provider) are left out of the loop.  Put simply: your patients get the letter but you do not.

Letter 1: Massage Violations

We’ve mentioned this previously, but payers continue to send out letters claiming that you are in violation of your state statutes for your massage fees with wild abandon.  The letter is simple and rarely deviates from its template form.

The payer accuses you of inflating your fees for massage.  They accuse you of violating your state law.  They agree to only pay your “cash” rate. And they threaten to take you to your state board.

Letter #2 is Aimed At ALL Treatment

Thanks to loyal blog readers, seminar attendees and my coaching clients, we have now seen  several examples of “Letter #2” from several different payers who all seem to be using the same template format to shoot holes in ALL of your treatment – chiropractic, massage, etc.

On the surface this letter looks like a matter of fact letter of explanation sent to your patient. The letter appears to focus on three things:

  • The patient is informed that that it is very likely that all of their care will NOT be covered by car accident insurance, PIP or MedPay.
  • The letter then instructs the patient to prepare to pay out-of-pocket for their personal injury related expenses.
  • To “help” the patient estimate their expenses that they will potentially be paying out of pocket, the letter instructs the patient to ask their provider for “non-insurance” cash discounts and/or self-pay prices and to record these prices on the letter to report and submit to the payer.

How Your Patients Perceive Letter #2

For your patients, there’s a lot to read between the lines of this letter. The evil brilliance of this letter is contained, not in what the letter states to your patient, but what it implies. And it’s method of “explaining” some details has the added affect of firing a warning shot before an attack. In our experience, your patients react to the letter in one of several ways:

  • Treatment Plan Paranoia: some patients get parked on the initial implication that all of their care will not be paid for and they immediately attempt to accelerate their treatment plan.  Of course, this can certainly jeopardize their ability to heal fully (or at all) from their injuries.  But the patient doesn’t understand injury treatment and has one thing on their mind: get out of this claim as quickly as possible (before the money runs out).
  • Buying Bare Bones Coverage: The second reaction patient’s typically have is also focused on the dollar, not on recovering from their accident related injuries. In an attempt to avoid any out-of-pocket expenses, patients choose a bare bones version of your recommendations for their care. For example, if you have recommended a course of chiropractic care, massage therapy and some active treatment regime such as therapeutic exercises or physical therapy, the patient will elect to skip out on some of your recommendations and/or limit the number of sessions that you feel are necessary. Again, this is not because your care is unnecessary or that they somehow feel your clinical expertise is off-base; it is simply because they are hyper-focused on the money.  The most ironic part of this equation is that they have already “bought” the personal injury coverage that would provide for their care as a part of their car insurance; but they are essentially trading in their purchased benefits for bare-bones coverage.
  • Pricing Problems: A third reaction common to patients who receive this letter leads to pricing problems. It is simply this: your patients suddenly examine every expense and fee you charge compared to your fees for self-pay or “cash” patients.  For some chiropractors, this is simply the wake up call you need to get more compliant with your fee structures.  For others, there is a dangerous implication that your fees are out of line compared to other providers (even if they are not) and/or that you are overcharging the insurance company or the patient (even if you are not).  Of course, some patients understand that there is a common practice among all healthcare practitioners or hospitals to offer prompt pay, cash or time or service discounts to self-paying patients.  However, what the auto insurance carriers know is that there are very few standard guidelines, written laws or regulations guiding how this is to be done properly.  Therefore, it is highly likely that your discounts can be construed as improper, not compliant and/or illegal. (This is similar to what letter #1 alleges.)

By instructing your patient to inquire about your fee discounts for self-paying patients, the insurance companies either get you to disclose your weaknesses in this area and/or display your fees in a light that is perceived as questionable to patients who don’t understand the practices of healthcare.

What to Do Next

There are three big take-home messages sent by these letters:

Chiropractors need to educate patients better on how to handle their injuries: Most chiropractors (and many healthcare practitioners in other professions) who have experience handling auto accident cases would laugh at the notion that the injuries sustained in car collisions or other personal injury scenarios are merely mild, self-limiting conditions that go away quickly. Of course, that’s what the patient hopes to hear; and the thought that these injuries may take weeks or months to fully heal is not a welcome one for patients. So a letter that puts pressure on patients to treat quickly before the bills potentially hit their own pocketbook appeals to the patient’s emotional desire to recover quickly from their injury and fuels their fear (both emotionally and financially) that it will not happen.  Simply put, chiropractors need to educate their patients on the nature of these injuries, the healing process and what it will take to get them well – focusing on their future and not their finances.

Get Your Fees Compliant Now: For those of you who DO have fee structures that are a flat-out flaky, this letter may expose your troubles far more and far faster than you would care to admit. For those of you who feel that your fees are a bit borderline, it’s time to shore up your ship. If and when your patients get a similar letter to this, you will be glad you are standing on solid ground; and those of you who aren’t will feel the earth begin to shake beneath your patient’s letter and actions.

Chiropractors need to educate their patients on how to navigate their PI claim: In a perfect world, your patient would be free from any financial conflicts of interest and allowed to focus on getting well.  Obviously, in today’s marketplace, this is not the case. From computer-generated algorithms, accusing adjusters and now these letters, the deck is stacked against your patients actually getting their injury fairly handled by the very insurance company and coverage that is supposed to take care of these incidents.  As their chiropractor, you are likely your patients best and biggest advocate to make sure that their health is top priority and that they don’t become a victim of the system or these sneaky tactics. Certainly, lawyers can help; but the patients actually trust you more because you understand the system AND you understand what their body needs to recover. And this is where your education can make a world of difference.

However, this education needs to happen BEFORE the letter arrives, BEFORE adjusters scare your patients out of necessary care and/or BEFORE some software system steals your patients benefits because the claims were not properly documented, billed, coded or communicated correctly.

Action Steps

Unfortunately, in this latter arena, chiropractors are notoriously failing.  We are struggling with our documentation, our billing, our coding (and yes, our fees) in the “regular” arena of insurance and we transfer the same bad habits and struggles to the personal injury work where the stakes are higher and the potential losses (and gains) are greater.

  • Take a chiropractic seminar that includes detailed strategies for getting your chiropractic billing, coding and documentation right. I’m partial to my chiropractic seminars, of course, but the real point is that you need perspective and a plan. Not to hide in your office with your own notes and hope they will someday improve on their own (they won’t).
  • Get guided expertise and help. Not everyone learns in seminars or implements well from courses.  If that’s you, face the facts and get help another way. Don’t be afraid or ashamed. We have tons of coaching clients who are bright and successful — and who do much better in a personalized program than a seminar.

Don’t jeopardize your patient’s health (and your paycheck), learn how to do personal injury correctly or refer your patient to another chiropractor who does.  It’s worth it to your patients and it’s worth it to you.

  • If you’re looking to learn strategies to protect your practice from letters like these and quickly improve or master your skills on proper billing, coding, documentation, compliance and personal injury case management, consider attending our upcoming Chiropractic Personal Injury POWER Seminar– where will be covering all the above and much, much more in the way of helping you rapidly improve your MVA coding, documentation, case management, billing and business strategies for a bigger, better, more profitable PI practice! Click the link for more details and to register.