Chiropractors are healers. You go to work each day seeking to relive or prevent pain. You certainly don’t want to fight with warrior patient attorneys who sometimes mislead you, strong-arm you, or flat-out bully you.
As a result, chiropractors often capitulate when pressed to reduce their bills. You give the attorneys what they want so you can focus on what you do best: healing.
While this might be the easiest short-term solution, it does a disservice to your team, your family and yourself. You work hard, and you deserve acknowledgment, proper payment, and respect. The unique situation in personal injury, though, is this: Litigation attorneys deal with pushback daily from adjusters and defense attorneys. They aren’t healers. They don’t need to be liked. And they expect to go through the day managing pushback.
So when you do with them, remember that you can and should push back and demand to be respected as a professional by presenting your case for proper (if not full) pay. In other words, use their own methods against them.
When you as a chiropractor decide to stand up for what is right, you can play a huge role in healing the broken system that is personal injury. The system is broken not because of the good attorneys and providers who do it right, but because of the attorneys and providers who go down a more unprofessional, if not unethical, path.
Realize, too, that patients very often get taken advantage of by their own attorneys, just as you do. When an attorney misleads a patient (their client) into believing that you have reduced your bill when no communication has even taken place, for instance, the patient doesn’t know they are on the hook for the full balance of the bill—and just might agree to a settlement without realizing their higher personal financial exposure.
One primary solution: transparency and more effective communication that includes attorney-speak.
So in this article, we take a look at communicating when attorneys are hiding things, misleading, or being overly aggressive with you, and what you can do about it. One caveat: there are some states that have mandated set-asides and mandated pro rata.
This article addresses chiropractors in states where the patient owes the bill regardless of the case outcome.
When an attorney says: “Your bill is unreasonable!”
Before we get to a suggested approach, let’s start with some preparation. One of the best practices for chiropractors treating patients on medical lien or letter of protection is this: Over-communicate with respect to your fees and charges.
- Within your lien, include your fee schedule, as well as a good faith estimate (GFE), per the mandates of the No Surprises Act.
- During patient intake, ask your patient to sign off on your fee schedule and the GFE.
- Send the patient and the patient’s attorney verifiable support that your fees are reasonable. Various sources can help you establish what “reasonable fees” are, including UCR (Usual, Customary, Reasonable) publications and online resources such as FAIR Health Consumer (www.fairhealthconsumer.org).
- Send interim billing statements during treatment and any updated GFE to both the attorney and the patient.
- Have the patient sign the full detailed discharge billing with an attestation above their signature attesting all treatment listed was rendered as presented.
- Upon discharge, send to the attorney and patient a packet that includes your discharge bill, the GFE and the support for the reasonableness of your fees and charges.
If you have done all of the above, and the attorney after settlement calls into question the reasonableness of your fees or charges, say something like this:
“If this had been an issue during treatment, surely you or the patient would have communicated with me at any one of the many times I communicated my fees and charges. The patient signed off on my fee schedule, my total estimate, and the final billing. All of these items were sent to both you and the patient. You and the patient were even sent interim monthly statements during treatment—yet nothing was communicated at any time, about any problem. You have also used my bills as evidence to support your damages claim. The issue you are presenting simply has no merit, as you can see.”
The attorney might very well come back with, “Well, it’s custom and practice to reduce fees to accommodate the settlement amount.”
This “custom and practice” does not exist anywhere but within the attorneys’ world. They cannot decide what is “custom and practice” within your industry.
With this in mind, keep reading!
When an attorney asks you to cut your bill.
When standing up for what is right, it is your job to make it abundantly clear to both the patient and the attorney from the onset that you don’t grant automatic lien reductions.
As a preventative step, let your patient and the attorney know that lien reductions will be granted on a case-by-case basis, and that requests for lien reductions must be made in
writing. This can be done in several ways:
- Add a clause to your lien or letter of protection that says: “The patient owes the full bill regardless of the outcome of the case. Lien requests are considered on a case-by-case basis and must be made in writing signed or acknowledged by the provider.”
- Explain this to your patient during the first meeting. Your script might sound something like this: “One of the most important provisions of this lien is that I am the only person who has the authority to reduce my bill. Sometimes attorneys will make a settlement offer based on the assumption that I will reduce my bill, but they don’t have the authority to reduce my bill without my permission. If you are told I’m reducing my bill, email my office for that confirmation before you finalize any settlement as I want to make sure you are making a fully informed decision. “In fact, it is illegal for me to agree in advance to reduce the bill later down the road—after it’s been sent to insurance. My bills have to be worth what they say they are worth when they are sent to an insurance adjuster; otherwise, that might be deemed billing fraud which I don’t engage in, and it certainly would not be helping your PI case. I do sometimes grant reductions, but they are on a caseby-case basis, and this happens down the line after I have completed treatment and as the case is about to settle. “When I’m asked to reduce a bill, my decision rests on several factors. Has the attorney disclosed how much the case is settling for, who is getting paid what amount, and anything else I should know to help me make a business decision on a lien reduction request? If don’t get my questions answered, I cannot tell whether the lien reduction request is fair. I also look to see if the attorney is also reducing their fees, which is only fair. Please remember that while your attorney might be on contingency, my office is not. We are agreeing to wait to be paid, but we do expect to be paid in full most of the time. “And, of course, if an attorney is not being transparent or is doing something wrong, I am less likely to reduce my bill. But when the attorney is cooperative, communicates often, and is timely, then I have more information and feel better equipped to make a decision regarding a bill reduction request. Does that make sense?”
And when an attorney and patient do ask for lien reductions (in writing, per your lien/letter of protection), say something similar to this:
“I do consider lien reductions on a case-by-case basis. To help me determine whether this is a smart business decision, I will need the details of the settlement and all intended disbursements of proceeds. I will need to know if you are also reducing your fee, a line-item breakdown of your attorney costs, what the other medical providers are being asked in terms of reduction, what the patient is intended to receive if all your lien reduction requests are agreed to, and whether there are any actual or potential additional sources of recovery such as MedPay, underinsured motorist coverage or other party defendants.”
And what about attorneys who send you a check marked “full and final,” but for a far lesser amount than the bill that is due? Very often, these attorneys with cite that mysterious “custom and practice,” or they will assert that civil code entitles their client (your patient) to a discount.
Try saying (or writing) this:
“I have received your check for $1,582, as well as your letter stating that this is my proportionate share of one-third the settlement, and constitutes payment in full.
The total bills received from my office were $4,932, to which I am entitled full payment, plus 10 percent interest, as my lien signed by you on December 1, 2023, states. Not to mention, by sending the short pay without my prior consent, you have breached the lien agreement. I am therefore voiding the check and returning it to your office.
If you now remit the full bill amount of $4,932, I will waive the interest accrual and any consequential damages because of the lien breach. Keep in mind that interest continues to accrue until the invoice is paid in full if you do not now send that full bill payment.”
Does this sound too aggressive? If so, keep this in mind: Attorneys fight all day long. They might push back, but the truth is: You are doing business right, and they know that. At the end of the day, the attorneys who value honesty and transparency will respect you, and respect goes a long way with attorneys. In fact, when you understand the personal injury arena, and you demonstrate that knowledge by standing up for what is right, the good attorneys will send even more business your way. After all, they will want to work with chiropractors who can defend the reasonableness of their fees in a deposition or a trial. You will then receive the acknowledgement you deserve, the pay you are entitled, and the respect you have earned.
