We often treat patients who have been in car accidents. This recent case is typical of a situation that often occurs: The patient’s insurance company used an agency to arrange treatment – in this case with us, as the patient insisted they wanted to be seen here. One of the rules of the agency is that we have to invoice them ‘only after conclusion of treatment.’ They will then invoice the insurance company for an amount that is more than the actual treatment cost.
In this situation the only advantage to the patient is that they do not have to pay for treatment up front before then reclaiming the cost themselves from the insurance company.
The disadvantage to the patient is that they are normally directed to practitioners who have accepted a lower fee, thus allowing the agency to make more money per treatment. The agencies will often justify this by implying that the practitioners they offer are specialists in treating RTA injuries. Often patients are being asked to travel long distances for treatment which comes at a personal cost to the patient in time, money and inconvenience.
The practitioner is also at a disadvantage as they will have to wait, not only until the conclusion of treatment for payment from the agency, but in most cases for a further 60 days from the time of invoice. Being a busy clinic we are luckily able to absorb this cash flow issue; some sole practitioners may not be so fortunate.
We have many reports from patients that communication with the agency is very difficult, if not impossible. We as practitioners also find that the pattern of communication is usually the same: We send in reports and invoices only to be told that the agency have not received them which simply appears to be delay tactics.
In conclusion, by involving a middle man there seems to be no advantage as far as we can see to either the practitioner, the insurer, or more importantly the patient.
The best thing to remember if you require treatment or legal help is that the choice of who you see or use is yours. Always insist that you want to see the person you have either been recommended to or that you already have an ongoing relationship with. If the practitioner is familiar with your body already this is a great advantage for the treatment outcome to be a success.