Act (IFCA). This is a crucial step in challenging this type of misconduct and determining the best timing of this is crucial. It is important to work with an attorney experienced in Bad Faith issues so they can help you and your patient navigate these situations.


Insurance companies can be aggressive, making it challenging to dispute their decisions due to their substantial resources and financial leverage.


As


mentioned earlier, they can profit significantly by delaying payments. By wrongfully denying a PIP claim or forcing the client to hire an attorney to contest the denial, the insurance company either avoids payment altogether or achieves a considerable delay, further benefiting from the prolonged process.


Happily, in the case study described here, we were able to get payment sent to the provider’s office. In addition, we were able to achieve additional compensation for our client, based on the misconduct of the insurance company’s claim handling.


Running a chiropractic office today involves far more than delivering excellent care. It requires navigating a complex landscape of financial and administrative challenges while maintaining patient satisfaction. Proactively addressing delayed reimbursements, streamlining billing processes, and communicating transparently with patients are all essential strategies for building a resilient practice.


Ultimately, chiropractors can mitigate the impact of insurance company tactics by adopting efficient systems, educating patients about their rights, and seeking legal assistance when necessary. By taking these steps, chiropractic offices can protect their financial health, maintain strong patient relationships, and continue to make a meaningful difference in their communities despite the challenges posed by insurance company practices.


—Scott Shawver is a Partner and personal injury attorney at GLP Attorneys, the largest personal injury law firm in the Pacific Northwest. He is based in the Seattle office and serves injured people throughout Washington. He leads the firm’s Bad Faith Insurance practice and is passionate about holding insurance companies accountable to doing what is right – and what is legally required – for injured clients. For more information about Scott and GLP Attorneys, please visit GLPattorneys.com or call 1.800.273.5005.


2. Streamline Your Billing Process


• Use specialized chiropractic billing software to submit claims quickly and accurately.


• Always send a copy of the chart note along with the HCFA form to ensure more efficient processing


• Conduct regular staff training to minimize errors in coding and documentation.


3. Follow Up on Claims Promptly


• Designate a staff member to track unpaid claims and follow up regularly with insurance companies.


• Develop a system for prioritizing older claims to ensure they don’t fall through the cracks.


4. Encourage Clients to Consult an Attorney


• Washington has some of the strictest legal requirements for PIP claims, making it essential for clients to understand their rights.


• A PIP claim can only be denied for one of three reasons: 1) the treatment is not “reasonable,” 2) the treatment is not “necessary,” or 3) the treatment is not “related.” (WAC § 284-30-395(1))


• Furthermore, a claim cannot be denied unless the PIP adjuster has consulted with a medical professional of the same specialty. (WAC § 284-30-395(3))


• Denying a claim improperly is illegal in Washington and may constitute misconduct by the insurance company.


• Consulting an attorney helps clients protect their rights. In many cases, when an attorney is involved, denials of PIP payments are carefully reviewed and often reversed.


5. Consider Alternative Payment Models


• Incorporate cash-based or membership-based payment options to reduce dependency on insurance reimbursements. Offer discounts for patients who pay upfront, which can improve cash flow.


Strategies to Address Delayed Payments


1. Verify Patient Insurance Coverage • Always verify a patient’s insurance benefits before their first visit to avoid surprises.


• Communicate with patients about their expected financial responsibility upfront.


Ple x us F eb/March 20 2 5


23


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32