Without it, Sleepless Nights Multiply

Analysis ● February 2020

 

Rendering care can, in and of itself, be a stressful venture.  After all you become the guardian of someone’s physical, mental and often spiritual well-being.  Regardless of the compensation involved, the human investment can be enormous.

In the Michigan PIP System, (Personal Injury Protection benefits associated with auto accident injuries) there are multiple facets that can contribute to anxiety.  That said, having the right perspective as a provider of care, recipient of care, (claimant) and other connected party can contribute to better relationships and less stress.

IME

The independent medical evaluation or examination is a common tool used by insurance companies.  Yes, the goal is to add credibility to current diagnosis or medical conclusions.  The goal can also be to discredit them.

While the doctors performing these are hired guns paid by the insurance company, most of us would like to think they are true to their oath and will render an objective medical analysis.

Providers can be quick to conclude this is the insurance company’s way to terminate benefits.  Of course!  At the same time for your own peace of mind think about personal diagnosis.  If you or someone you love was diagnosed with cancer, what is the likelihood you would seek a second medical opinion?  It is very likely.

Well, an insurer or an ancillary claims financier, i.e. Michigan Catastrophic Claims Association, could be on the hook for millions of dollars in long-term care after a Catastrophic injury.  Is it unreasonable for them to ensure the diagnosis associated with the multiple bills they are receiving are legitimate and rooted in legitimate medical conclusions?

Relationships:  Insurance Adjusters are often villainized and perhaps some deserve it.  There is, after all, a certain impropriety or even sleaziness associated with their offering unqualified medical opinions or seeking to intimidate uneducated claimants for the sole purpose of minimizing reimbursement totals.

However, if we approach the relationship with an understanding of their job responsibilities, perhaps everyone can have a better experience while interacting with one another.  Fraud is not a very well-hidden secret.  Some see a money pot and chase it based upon their own rules and will not stop until they get caught, if then.

Adjusters are not blind to this reality.  If you were them, would not your “alert antenna” stay raised?  Surely those among them who are sane do not want to live their lives in a bubble of paranoia.  At the same time, they have an obligation to test everything that results in an invoice being generated.

Without such a test, illegitimacy would dominate the care and reimbursement process to everyone’s disadvantage.  Remember, providers looking for a quick buck without honor will often not challenge such a test and walk away.  At this point the insurer wins as does everyone else who looks to utilize these benefits responsibly and honorably.  As these scammers walk away, those among us who are legitimate will fight for what we are owed.  We then pass the test.

It is surely annoying when honorable providers are subjected to this test, however, if accepted as part of the process of operating in a deeply flawed system we will avoid taking such scrutiny personally and learn to prepare for it.

No, this does not mean either side should accept abuse from the other, misrepresentation of conduct or any activity or conclusions steeped in bias, impropriety, illegality or vendetta. Let’s just be sure we have the facts, before we let our minds go there.

Yes, there is major value in having the right perspective.

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Another Blog Post by Direct Care Training & Resource Center, Inc. Images used are for the purpose of complementing the written content and do not imply an affiliation with or support by any individual or organization and may belong to their respective copyright holders.