As if being injured by someone else isn’t bad enough, now you have to navigate the world of doctors, multiple auto insurance adjusters, car repairs and sales, tow trucks, attorneys, and many more intermediary people. It is stressful and often everyone around you has different opinions on what you should do and how you should do it. To make it even more difficult, conflicting advice from doctors and attorneys often come up and need to be sorted. One such area of this labrynth is how the payment is handled for the medical care required to fix your car accident
This brings up a very large and important topic in today’s world of ever increasing deductibles, in and out of network providers, copays, coinsurance, insurance verification, non covered services, and auto accident documentation inequalities compared to health insurance documentation requirements. There are times when it can be advantageous to use health insurance and times when it is advantageous to not use your health insurance.
First off, the primary insurance that is to be used when you are in a car accident is your own auto insurance. There is a benefit that is called Med-Pay
on your policy specifically to be used to pay for your medical care. Your insurance rates will not go up if you use this benefit. Your first step is to call your insurance and get a claim number for your Med-Pay. If you do not have Med-Pay, you can use a car accident lien
to pay for your medical care and bypass your health insurance all together. Lets break this quandary down and get to the meat and potatoes of this friendly advice on how using health insurance may hamper your care and wallet.
1. Lower Quality Care
: For example, Blue Cross Blue Shield will reimburse a chiropractor $41 regardless of which procedure being performed. I can do 1 procedure or do 10 procedures and the clinic
will still get $41. This leads to doctors playing the volume game. Why would a doctor spend a 1/2 hour on a patient when they get the same for spending 1 minute on a patient. You lose out on quality health care and makes you more vulnerable to permanent injuries. Aetna, Denver Health, Cigna, and Kaiser are even worse when it comes to reimbursement. Columbine process those insurance and takes $13 off the top, this can lead to reimbursement being lower than medicare reimbursements. Not to mention the cost on the provider just to submit a claim. The saying you get what you pay for rings very true in this case.
2. Up Front Cost
: You will need to verify your health insurance benefits. Set aside at least half an hour or more to do this as it can be very confusing, especially if you need procedures that are not covered by your health insurance. Most people’s health insurance plans have very high deductibles, greater than $5K is becoming customary. This places an undue economic burden on the patient that will dissuade them from completing a treatment plan. Costs can reach thousands of dollars in a very short period when they have to see MD, PT, Chiro, Specialists, and complete imaging. Other than meeting deductibles, lots of manual therapies, such as ART, Graston, Massage, Dry Needling
, and Cold Laser are not even covered by health insurance.
3. Providers in Multiple Locations: Ideally, your care should be multifaceted utilizing an MD, Chiro, PT, Massage, Imaging, and potentially more providers. This is an obstacle that adds an extra barrier to obtaining quality care in a timely manner. This also creates a large disconnect between providers, which decreases quality of treatment. Our clinic, for instance specializes in car accident care in Denver, CO and is concierge style where we have all providers and imaging options in one place.
4. Decrease Quality of Medical Records
: This is one area that is often over looked in car accident care. Your injuries need attention and care, but the legal side of your situation needs the same. For example, one of my patients was recommended that she a Spine Surgeon and use her health insurance for problems with a suspected facet joint by her attorney. I was able to treat her initially, and with conservative methods brought her up to 80% normal. I advised her to see one of our specialists that does not accept health insurance, but her attorney told her to use her health insurance (purely for economical reasons). She went to Denver Health and received a Facet Injection. The doctors records indicated that this procedure was a complete success. The patient ceased care since the doctor
told her that the procedure was a success. She tells the attorney that she was discharged. Initial settlement comes out very low because the doctors notes say that the procedure was a success without any follow up. I run into the patient, we talk, she says that she is still 80% normal. She received a facet injection, which is purely diagnostic and not meant for long term therapy. Her health insurance failed her, and her attorney failed her, and she is still in pain with documents that do not support it. Health insurance doctors work on volume, in which quality of care decreases and documentation standards become sub par.
5. Case Management Shifted to the Patient/Client: When patients are going to multiple locations for care their is no single person in charge and this is when patients fall through the cracks. Their is no coach or quarterback. This leads to people not getting the correct care or documentation for their automobile injuries. General medical doctors are not specifically trained in automobile injury case management or documentation. Not to mention, some doctors will not treat auto accident injuries as liability increases and the fact that this puts an extra burden on a clinic as record requests and administration time increases for car accident related injuries.
6. Health Insurance Limits: Most plans only cover so many visits of physical therapy and chiropractic benefits. In some instances, the client/patient will need more visits than what their policy will give them.
7. Subrogation: Your health insurance will require you to pay everything back that they paid the providers via your settlement proceeds. This can be difficult on your attorney as health insurance companies are less likely to negotiate their bills. Usually, health providers that hold their own liens are much more acceptable to fee reductions once the settlement as been negotiated with the at fault insurance company.
As you can see, there are many pitfalls to using health insurance. One of the biggest areas is not having access to non covered services, ranging from cold laser therapy, dry needling, stem cell therapy, unique imaging such as CRMA’s, prolotherapy, and more. The absolute priority that trumps all facets of your situation is the quality of your care that will help minimize your chances of having a permanent injury.
Dr. Trent Artichoker MS, DC
3890 Federal Blvd Unit 1
Denver, CO 80211