JUST SAY “NO”
The Difference Between Settling and Winning in Personal Injury
“Personal Injury attorneys and insurance companies expect lowball PI settlement offers are good enough. We are proving they are not.”
Just saying no sounds like an easy thing to do, but during the negotiations process, circumstances can make this quite challenging. This article focuses on chiropractors who accept PI patients on lien, “do it right”, bill reasonably, treat competently, and operate a “for profit” business” yet are consistently asked to reduce their bills.
If this resembles you, then keep reading. It is time to take a firmer position and get paid fairly on your PI bills.
Why is this important?
PI business can be your most profitable segment. It is a source of business that you want to actively grow. To thrive in PI, you need to assess your business, the profitability of working with select firms and take measures to improve your results. Marketing to those attorneys that accept their dual-fiduciary responsibility, and seek to protect your interests as well as their clients (your patient), is a great business decision. As one example, they will not have an issue signing your lien and will work hard to pay you in full. For those who consistently work against your best interest, it is time to learn how to turn the tables and take control. There may even be some law firms that just are too difficult to deal with and you may opt to cut ties.
What is the biggest obstacle?
For most chiropractors, the #1 issue resides with attorneys who really push for steep ductions. Although some genuinely want your bill to be paid in full, there are others who don’t operate on that premise. Why do those attorneys think they are worthy of receiving 35% to ti0% of a settlement, but want or expect you to significantly discount your fees, and don’t believe your medical bill is legit or that your fees are warranted?
Why do they want to push a false “rule” like the mythical 1/3rd pro-rata of settlement fees, when for example, you are a hands-on treater vs. a high volume, high profit margin MRI center and shouldn’t be thought of as the same?
There really isn’t clear justification, but many attorneys have operated this way for so long and gotten away with this practice, that it becomes almost routine. Is there something wrong with
you wanting to be paid fully? Should you feel badly, embarrassed or that you are being “unfair” seeking proper and fair payment? Hopefully, your answer is “NO!” It’s time to start saying it.
A good starting point in changing the dynamic between you and the attorney is to clearly lay out your expectations in your lien. Have a lien with the most expansive protections. MLR invites you to download its proprietary lien at www.mlrportal.com and adopt it, or at least compare it to your own and see where you can strengthen it. This action helps all the parties involved by establishing the rules in advance, including but not limited to; you will not accept any reduction in advance, the patients is responsible for the bill, the lien includes interest clauses in case of breach, and specifies the expectations of the revenue sources such as MedPay, PIP and third party insurers.
To better understand how unfair and one-sided the expectation is of your accepting low offers, simply look at the attorney’s own bill. They are on contingency while you have agreed to wait to be paid. They want you to take steep discounts (and in common fund states waive the rest of your bill), yet they are not only getting full fees but their costs reimbursed as well.
So why is it assumed that most chiropractors will accept so much less?
Sometimes it is because of the threats, implicit or stated, to cut off referrals. The belief that business at hand is better than none at all, even if it is not as profitable as one would like, is not in your financial interest. Too often, it’s letting “fear” or the desire to be “nice” that allows others to take advantage.
In many cases it comes down to just not knowing better, that limits your ability to advocate and negotiate on your own behalf. This doesn’t mean you don’t consider reductions, only that you want full transparency and need all the necessary information to make an educated decision when being asked to do a favor that you aren’t, by law, required to do.
Follow the mantra of Ronald Reagan when it comes to what attorneys and patients tell you: “trust but verify.”
Another thing to consider is to not have different rates such as cash rates. However, if you are going to have cash rates and they are more than a 15% reduction, I recommend you put in place
a “Patients Financial Hardship Program” and have the patient fill out a form detailing their distressed financial condition and keep it in their patient file. If you do, at deposition or trial when
defense counsel asks you about your cash rates you can explain this away as “unique” to help
patients in need, rather than it reflecting your true bill worth. The patient’s attorney will appreciate you approaching it this way, so that your billing is less subject to attack. The additional
problem with cash rates is that even your patient’s own attorney, while using your bill offensively to get a higher settlement, may post settlement bring up your cash rates as a tactic to also
have the payment on your lien reduced. So, taking this approach can help protect your patient’s case, help the attorney, and help the payment of your own bill in full.
One key way of confirming if your fees are reasonable is to visit fairconsumerheath.org. Fair Health is funded by the insurance industry and is surprisingly favorable to chiropractic fees, showing average fees by specialty and geographic area. The averages shown are actually lower than the true averages because they incorporate Medicare rates and also use just the first three digits of the zip code to bring in lower economic areas nearby. Even so, their listed “out of net work” averages, which is the one you look for when determining “reasonable fees”, are often higher than what you probably currently charge. This matters when you are asked to justify your fees. Remember, the adjusters will look to run your fees and codes through Colossus or like software, assessing your billing practices, so don’t let that be an issue. Getting this fee support, as an example, to the attorney at the time you send the attorney your bill allows the attorney to head off bill push back by the insurer and you have then already helped their case more than other providers who fail to provide billing support early on to the attorney.
It is prudent to be familiar with the Arizona Attorney Code of Ethics which specifies the attorney’s obligations. This allows you to know what is acceptable behavior or just a tactic they practice. In general, it is trusting in your worth, knowing you treated your patients ethically and soundly and that you deserve to be compensated for the time and effort you put in to improve
the patients’ health. Let that be a driving force.
Start by saying to the attorneys that you have taken less from them for a long time and that it is
time to turn the tables and have them compensate you fairly. Don’t let fear stop you from advocating for what you have rightfully earned.
Learn to say “NO!”
