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Thursday, March 10, 2022

BREAKING NEWS

Insurer Claims Over-Treatment but Pays $712,500 UM Verdict in San Diego

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Stephan parked his Snap-On Tools work truck in an alleyway and was inside the back of his truck with the engine off when defendant struck his truck. Defendant admitted he hit the gas rather than the brake just before rear-ending the truck.


The collision knocked him over and caused his toolbox to strike him on the left side. He lost his job and still suffers back pain.


Stephan received chiropractic care and epidural injections. Later, he had a microdiscectomy procedure and experienced some relief. He had prior back surgery many years before.  


Defendant argued his bills were inflated. 


Stephan argued that any bill more than what his insurance would have paid was his choice to incur because he had the right to treat with any doctor of his choice outside his insurance plan. 


Defendant claimed that accident didn’t aggravate his condition because he had a pre-existing spinal condition. Defendant also claimed that his surgery was unnecessary, and Stephan did not want to work anymore. Defendant insurance company placed Stephan under video surveillance, searched all his social media, hired investigators to create a “book” on him showing that he still lived a full life, and that he should have stayed with his network doctors. 


The total medical bills are $100,000. Defendant’s final offer was $188,000. Stephan demanded $1,000,000 policy limits. 


Award was $712,500.


Stephan vs. Great American Insurance, San Diego Superior Court. Hon Ronald Prager, Ret.


FEATURED ARTICLE

Most Common Chiropractic Audit Triggers

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Big Insurance is surveilling you, your clinic, and your patients.


They always profile your claims history. If the frequency of your claims, billing codes, visits, treatment durations, or other indicators fall outside of their parameters, an audit is triggered.


However, if you carefully document your justification for care, you should be audit-proof. All you need to do is show “medical necessity."


  1. Seeing a relatively high number of Medicare patients within a certain time frame.
  2. Disproportionate use of the AT modifier. Is the active phase of the care you provide significantly longer than other chiropractors?
  3. Subluxation diagnosis code and neuromusculoskeletal diagnosis code mismatch. Medicare uses the diagnosis code to determine whether to expect a short-term, moderate-term, or long-term treatment plan. 
  4. Repeated or excessive use of the 98942 procedure code.
  5. A higher-than-normal number of visits that suggests over utilization or lack of medical necessity.


For numbers 6 to 10 and the free how-to form contact: johntawlian@shawnsteel.com.

SSLF Paid These Docs 100% in February

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🔥ACE'S LIT TIPS 🔥

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Just talked to a doc on a case with an Uber twist.


I was recently asked at a seminar whether an attorney could withhold the settlement amount from Uber, from the doctor claiming a confidentiality provision in the settlement agreement.


There is debate about this subject, but the best answer to this questions is: You’re right, Mr. Attorney, I don’t need to know how much the case settled for…so long as you pay 100% of my bill. Of course, if you want to negotiate for a reduction, I’ll need to know that information.


Don’t’ let sneaky attorneys beguile you out of your hard earned fees.


Feel free to contact me at alexandereisner@shawnsteel.com.

UPCOMING EVENTS

MARCH 23, 2022

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Dr. Fox will be discussing the affects of motor vehicle accidents on your patient's brain and spine -- and what you should do when you see the trauma in your patients.

CLICK HERE TO REGISTER

APRIL 5, 2022 - ORANGE COUNTY

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Approved for 2 CE hours (1 CE in ethics and billing, 1 CE in principles of practice). Please join us at Buca di Beppo in Huntington Beach.

CLICK HERE TO REGISTER

MAY 10, 2022 - RIVERSIDE

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Approved for 2 CE hours (1 CE in ethics and billing, 1 CE in principles of practice). Please join us at The Mission Inn in Riverside.

CLICK HERE TO REGISTER

JUNE 7, 2022 - LOS ANGELES

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Approved for 2 CE hours (1 CE in ethics and billing, 1 CE in principles of practice). Please join us at the Flame International in Los Angeles.

CLICK HERE TO REGISTER

FEATURED VIDEO: SSLF PODCAST

EPISODE 20: ALL EYES ON YOU, DR. CHIROPRACTOR

Please subscribe to our YouTube channel! CLICK HERE

ADDITIONAL RESOURCES

Check out our website for helpful articles and resources to help you succeed!

View our past PI Email Alerts to catch up on breaking industry news.

If you missed a recent PI Webinar, listen to our recordings of them.

DOCTOR'S RESOURCES

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PODCAST CHANNEL

SHAWN'S ETHICS CE COURSE NOW ONLINE

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Interested in earning Ethics CE in the comfort of your home or office?


Shawn's Professional Boundaries: Scope of Practice is now ONLINE through WebExercises! Sign up by clicking the link below or using the QR Code.


Include our promo code: ETHICS20 at checkout for 20% off.

Click Here to Sign Up


Contact John Tawlian with any questions johntawlian@shawnsteel.com.

CONNECT WITH OUT TEAM


SHAWNSTEEL@SHAWNSTEEL.COM | (949)551-9000


LOS ANGELES, SAN FRANCISCO, ORANGE COUNTY


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