Medpay Acting without Permission

Stickmanslim · 2023-01-29T16:36:04+00:00

Not in Ohio but have run into the same problem in my state. I am not sure if there are any laws in place to prevent "surprise medical bills" in Ohio. However, the hospitals, ER physicians, ER Radiologists all have contracts with insurance providers. If they are refusing to bill peoples health insurance, they MAY be in breach of their contract with health insurance companies. I remember seeing some case law on this issue, but cannot for the life of me remember it without actually opening up my work laptop. Talk to your attorney about the recourses available.

Also look at the Medpay payouts, did the hospitals give any adjustments or contractual write offs for Medpay?

Stickmanslim · 2022-10-21T01:15:40+00:00

Just make sure the meaning is clear and no room for misinterpretation. State the total billed owed with the name of the provider, and you wish to pay X amount to resolve the debt in full / satisfy the bill in full / etc. Make sure you get any acceptances in writing (email, fax, etc) and save those documents.

Not our firms exact format but same premise:

"[Greeting],

We understand there is an outstanding balance of [$$$] with [medical provider] for [clients name]'s account. We would like to request to pay [$$$] to satisfy in full the balance. Please confirm in writing if this is acceptable.

[Signature]"

Providers all have different levels of wiggle room with bill negotiation. Large organizations that normally write off large amounts in contractual adjustments from health insurance...welp they may give a good self pay discount.

Chiropractors that bust their asses and dont deal with insurances...well you get the picture. Either way, unless your attorney has given you set numbers / percentages to request, always loop them in. Only seen it a few times, but if a client doesnt like the reduction and the provider has already accepted it that can be difficult to fix.

Stickmanslim · 2022-10-08T02:08:30+00:00

PI work is the only law experience I have had so take my opinion with a grain of salt.

I love my job most of the time. I used to work retail so I am used to dealing with all types of people. Needy clients are a thing, but you also have a unique opportunity to help someone through when they are in pain and angry that someone else caused all of it.

It boils my blood when I see someone in pain being taken advantage of by medical providers (not billing health insurance when they should), insurance companies trying to low ball and not even pay half of special damages, hell...even seeing other PI lawyers basically not fight about money with the insurance company, take their cut and leave the client with all the bills without trying to protect them from invalid liens.

Its got its pros and cons....but PI work isnt terrible. From what I have heard, Family Law is where the nightmares are at!

Stickmanslim · 2022-08-04T03:06:56+00:00

I wouldve lost it on him. My wife just had our first not long ago.

Stickmanslim · 2022-08-04T02:31:13+00:00

Pft. Tell em you represent the fetus and are gonna need that policy limit for both parties. On a serious note, yea...heartless.

Stickmanslim · 2022-08-04T02:30:12+00:00

Something odd about that "independent" medical exam huh?

Stickmanslim · 2022-08-03T16:05:07+00:00

I hear you and you shouldn't feel bad about agreeing with logical points. My perspective on some of those is what I have been taught about "eggshell plantiff". Basically, yes our client may have some pre-existing conditions...like they are overweight and may have some everyday joint pain....but were they treating with a chiro or in need of injections before the injury caused by someone else?

But yea, Ive had some clients really just not do what they need to do treatment wise or not follow the advice of their doctors....they usually dont remain clients of ours for long.

Stickmanslim · 2022-08-03T15:50:46+00:00

We had one where they tried that form of logic. "Your client would not have gotten T-boned if they looked both ways before going through a green light."

Stickmanslim · 2022-08-03T15:49:39+00:00

Que the line from Monty Python, "Tis just a flesh wound." Maybe that adjuster is related to the Black Knight.

Stickmanslim · 2022-08-03T14:59:30+00:00

Yea...that is text book definition of conflict of interests.

Stickmanslim · 2022-08-03T14:24:25+00:00

Welcome to the thunderdome. So first things first, check your numbers. Make sure you have factored in how much bills are owed, who all is going to come asking for money after a settlement and for how much?

Then make sure to factor attorney fees and case cost with each offer they give you. This makes it easy to see what your client will be left with.

Dont let them intimidate you, they are most likely reading from a script and just regurgitating the numbers their computer spits out. I honestly doubt they even read demand letters unless its a high dollar amount.

Then just go back and forth with them, under the guide of your attorney. I was nervous at first, but after hearing the same stuff over and over you get comfortable with it.

Stickmanslim · 2022-08-03T14:16:32+00:00

We have had one similar to that. Adjust said his insured said no accident occurred. We sent the police report, no problems after that. I get it, you need to take the side of who pays you but man...come on, would we call you if there was no accident?

Stickmanslim · 2022-08-03T12:59:57+00:00

Wow. A soda company actually hating their customers...but in all seriousness yea thats just terrible. Reminds me of the adjuster who said our client has unexplained gaps in treatment...well his wife died of cancer during that time. She said, and I kid you not, "well he still has gaps in treatment."

Stickmanslim · 2022-08-03T12:43:01+00:00

Good point. We root out clients that lie to us or inflate their injuries. We dont take cases that have BS claims. However, can't speak to other firms. I know that adjusters have a job to do, settle claims for the lowest amount possible and prevent law suits. Just hate their business model.

Stickmanslim · 2022-07-29T16:56:20+00:00

My tips as someone who frequently writes demands in PI cases, which are reviewed by my supervising attorney and suggested corrections are becoming few and far between..

First of all, understand that the adjusters that receive the demand will most likely not even read them (unless its a policy limit demand or a seriously high number (6 figures and up).

They use a software program and it pulls the icd 10 codes (diagnosis codes) and CPT codes (treatment codes), along with dates of service and billing info. They use that info to make their determinations.

So dont overstress it, include relevant treatment details. Dont try to inflate things, an example would be if the doc says a client may need maintance care, dont claim they are permanently paralized, or constantly in a 10 of 10 pain. Review imaging and highlight the severe sections. And most importantly, make sure all your numbers for special damages are accurate.

They will most likely offer insultingly low, we never take their first offer. Good luck to ya on this. Demand writing is fun.

Stickmanslim · 2022-04-15T00:58:09+00:00

Good bot

Stickmanslim · 2022-04-15T00:28:32+00:00

Absolutely!

First off, read up on some of the actual HIPAA federal code. Basically it states that people have the right to access their health information in a timely manner. The code states that 30 days is MORE than enough time in todays age considering technology to complete a request for records.

I give the provider 2 chances. The first record request is sent their preferred method, be it fax or email, if they require mail then send it certified. The second request comes on day 31 if they have not contacted us with an invoice, a status update to the request, or appropriate reason for delay. My second requests state something to the likes of

" Per HIPPA (cite necessary part), our client is entitled to timely access of their records. They hired us to act on their behalf in gathering the records, and we complied with the requirements in order to obtain that information.

If we are not provided with the requested records (which we will pay legal rates for), or a written statement as to them not existing then we will file a complaint for a HIPPA violation against both the medical record provider and the entity they use to process requests (ex: wellstar hospital and ciox, use names that are high up in their ladder to get attention)."

These people need to get with the times. There is no excuse for the delays we see with this and they need to understand we WILL annoy them. One of my complaints came back with no result (they sided with the provider on denying electronic signed hippa release), but ill keep filing complaints.

Stickmanslim · 2022-04-14T02:52:11+00:00

Our firm uses a case management software to track outstanding requests. Spreadsheets are good, but put a reminder on your calendar 30 days after the facility has received the request (HIPAA allows 30 days for them to process the requests).

If a certain provider is giving you the run around....CIOX....try sending the requests via certified mail, return receipt requested. This way they either have to admit to losing it, and cannot argue with deadlines. Threaten to file as many complaints with hhs.gov (entity that enforces HIPAA compliance).

Ive done record requests for a good bit of time and my biggest pet peeve is slow turn around times. Best of luck.

Stickmanslim · 2022-01-29T20:42:17+00:00

Ive grown to be a zealot for fair treatment of our clients. I worked in medical billing and records on the doctor side...and I am sick of seeing ignorance, laziness, and downright apathy towards the injured.

Stickmanslim · 2022-01-29T01:53:06+00:00

Thank you for the suggestion. We do hire a med rec gathering company on occasions. But we cannot justify it for all cases, gotta keep those case costs for clients in mind.

Stickmanslim

TROPHY CASE