Dear Body Well friends, clients and colleagues:
We’ve all seen the commercials, the billboards and heard the radio commercials. “When you’ve been injured – after 911 – call 411-PAIN!
Many people have no idea what 411-PAIN or similar companies really are, or what they do! Are they lawyers? Doctors? Both? From what I gather, they are usually chiropractic practices or pain clinics that also employ doctors, but they work closely with a select group of lawyers with whom they exchange referrals. When you call after an accident, their goal is to have you come into their facilities for treatment, and to refer you to one of their select attorneys. These attorneys reciprocate by referring their injured clients to the clinic for treatment.
So what’s the problem? Many people need medical treatment and legal counsel after an accident, right? Of course this is true! And let me be clear that I have no doubt that there are many dedicated health care professionals working at these types of facilities who are sincerely concerned primarily with their patient’s health. However I recently discovered first hand how going with an organization like this could be detrimental to accident victims who genuinely need ongoing therapy through their auto insurance policy benefits.
The problem is that organizations like this are extremely aggressive in treating injuries and make a habit of billing as much as possible, as quickly as possible. Their goal is often to provide the maximum amount of treatment, including therapy, consultations and expensive diagnostic tests, in order to bill out 100% of available benefits while they have “control” of the patient (and before they potentially seek therapy somewhere else).
In other words, let’s say you have $10,000 available in medical benefits through your auto insurance (everyone in Florida automatically has at least this amount). When you get to the 411-PAIN type clinic, it could be argued that they are going to try to bill as much, if not all of that amount as quickly as possible by prescribing virtually every conceivable procedure and test they have at their disposal. And they have many of them!
So while they offer a variety of medical therapies (which in and of itself is fine)the problem is that even when you feel that only certain ones are beneficial, they are still going to try to persuade you (or insist) that all of the other expensive therapies and repeated diagnostic tests are also necessary. Your insurance company knows this! And they don’t like it!
In fact, the reason I was inspired to write about this was because one of our long-time cash clients had been injured in an accident, and initially decided to call a company similar to 411-PAIN. They quickly prescribed and performed everything you could imagine. Within just a few weeks, the insurance company, seeing the bills pouring in, insisted that the client get an IME (Independent Medical Exam). Sure enough, the insurance company-paid doctor determined that she did not require additional therapy. Her benefits were then suspended immediately.
So even though she still has symptoms from her injury and received a prescription for massage therapy from a completely different doctor, she is now unable to use any more benefits. Her only recourse is to work through her attorney. I had never heard of someone being cut off so quickly so I decided to look into it myself. I called her claims adjuster at the insurance company and asked if this was more common when dealing patients going to the 411-PAIN type clinics and he made no secret that this was indeed the case!
The moral of the story is that if you’re injured, it’s important that you don’t get taken for a ride by a medical provider more concerned with blowing through your benefits than in providing the most cost-effective therapy possible. The provider should also respect that your benefits are eventually going to cap out and help you to plan out your therapy keeping that in perspective.
Remember, it’s your health and they are your beneifts – don’t let anyone wrestle control of that away from you! It’s never a bad idea to see your family physician first and go from there. And if massage would help you, we’re more than happy to provide that if you have a prescription from your doctor.
Daniel Melmed, L.M.T.
Owner, Body Well