Part of the challenge when a patient initially comes in for treatment after a motor vehicle collision is they want to use their health insurance or their attorney asks them to use their health insurance. I am going to make the case that this will destroy the case from the inside.

As a health provider and chiropractor for over 23 years, the reimbursement from major medical insurance is roughly 1/3rd it was when I started. Show me an industry that makes less for the same services over this period. The money in health care is in administration and the insurance companies themselves. That is one of the main reasons I decided to put my resources into doing good work in personal injury.(Multiple certifications and near 800 CE hours in medical/legal)

As a healthcare consumer that pays for his own insurance I understand the frustration when I can’t use my insurance or the copays and deductibles are exorbitant. This is also the frustration when an accident victim is asked to pay their deductible for a crash they didn’t cause.

Thus the necessity of a lien. Be that they are filed at the county or just a consensual lien this allows the patient to be seen with no out of pocket costs. But I am going to prove that when it is done right will ensure the best outcomes clinically and settlement wise.

One last point on using health insurance. #1 typically the patient has no idea what kind of coverage they have and is shocked when we tell them. #2 attorneys have never and will never check health insurance coverage of their client. (Attorneys must have amazing policies personally?)

I get it that if a case is run through at healthcare insurance reimbursements the client and the attorney have more for themselves. This is the reason I am out of network with everyone so as not to be forced to take a mere pittance for the excellent work I have done. 

I practice in a state that allows balance billing so ultimately if the scenario makes sense, like the patient has met their deductible, we try to be reasonable. Often the claims are denied or later have to be subrogated at the end of the settlement. If you practice in a state that doesn’t allow balance billing be very careful if you are in network as you may be stuck at your contractual rates.

The legal community overall perceives all doctors must be the same. It makes no difference who their client sees as they are the ones that will put everything together and fight for the appropriate settlement. 

I often address this fallacy with an attorney asking, “do you not know who to send your client to or do you not care?” Just as attorneys specialize in criminal law, business law, estate law, personal injury, so do medical providers. We are not taught about personal injury treatment in school. 

The best medical specialists work in this arena. I know I am 10x the doctor I was before pursuing this path. I was embarrassed I was the weak link on cases 15 years ago and decided to do something about it. 

The saying “you don’t know what you don’t know, until you know,” is so true in the PI world. We add value to a case. We build the case from the ground up and include medical validation and specialist when appropriate. We test for ligament instability on day one so we know the location and severity of the injuries.

Our network of trauma trained radiologists understand what is acute and what is chronic. There is nothing worse than a poor MRI read. 95% of radiologists will read an MRI like the patient is a Medicare case. If you want proof I have over a dozen reports that a staff radiologist read before the trauma radiologist and you would think they were different patients. These highly trained radiologists won’t take health insurance. 

The other medical specialists in pain management, orthopedics, trauma counseling, neurologist, and neurosurgeon often will only see you on a lien. These bills may be more but you definitely get what you pay for. 

After all, the case value is built on the injury and the necessity of care to make the patient whole again. If you rely on inferior providers to add value to your cases I hope you see your business model is flat out wrong.