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PIP Issues: The choice is clear; Shall our patients continue to be victims or become pro-active to change things?

    All Florida DC’s were affected by the Draconian changes made to PIP legislation in 2012. One of these changes, the two week limit to seek treatment after an auto accident, has clearly been of harm both to patients and to Chiropractors. We routinely see patients who have had trouble for months before consulting us. Accordingly, it would certainly help Chiropractors and their patients if that provision could be changed to something more realistic, like 4 or 6 months. The only way to get that done is via legislation in Tallahassee – no easy task Doctor.

    There are many well heeled competing interests who want things to remain as they are. The record shows that we think (mistakenly) that these big money types get everything they want. That’s simply not true. Their big contributions guarantee only one thing – that is access to legislator(s); the ability to make their case one on one and seek their votes on favorable legislation. However, that access does not guarantee their positive vote – not by a long shot.

    The fact is that we have the same – possibly even better – ability to lobby for change. Understand Doctor, that the Florida legislature is HUGE. There are 120 representatives and 40 Senators. Getting a majority of them on our side of an issue will take more than sending a few paid lobbyists into their offices several times a year. They respond to pressure – and personal contacts. And the truth Doctor, is that we have that in spades. We just fail to use it.

    In the paragraphs ahead I will set forth a number of effective approaches to getting more legislators on “our” side to remove or change that two week limit in PI cases.

    Legislators are in a position to hear both sides of most arguments. In addition to being approached personally by well heeled lobbyists they are also approachable in other ways – like well written First Class letters that address the issues (not emails, which are too numerous to be effective). Think about it Doctor; with emails flying around anymore when do you ever hear of a personal letter being sent? That’s my point. We can do our patients and ourselves the most good with well written first class letters sent via the US Mail. Another vitally important approach is to have your patients – those who have been harmed by that two week restriction – write a letter describing the harm the current law has done them (cheated them out of legitimately due treatment benefits with the stringent two week limit). Letters from patients directly harmed by the two week limit are quite convincing. Solicit them from your patients. If necessary help them write that letter. Give them the stationery and a clipboard. Have your staff type it out on plain paper if needed – and you can mail it from your office – with your stamp. Below I have offered a few model sentences you might suggest.

    And you never write just once. Write again in 2-3 months. We need dogged determination to get this job done. You can’t let up. Explain the need for continuing effort to your patients and get them ready to write a similar letter in a few months (keep track of this in your records).

    With respect Doctor, we have been entirely too passive, relying on our few lobbyists to do it all. Think of it: there are 160 representatives in Tallahassee outside of the Governor and administrative people. We have tasked a few lobbyists to reach them all and keep them aware of our needs – a clearly daunting task at best. Our lobbying people need OUR help – Our PATIENTS need help. We, you and I, are a huge, practically unused resource in helping to move our issues. The good news is that it won’t cost you more than a few dollars – and it will cost you some time. Time‘s inexpensive – and I believe you will see that this effort can also become a very respectable way to get better known (and patronized) in your community.

    Another  important thing we should do – but don’t – is to attend meetings where those legislators will be speaking. Call their office and find out where and when they plan to be in the district. Attend those meetings. You can get by without taking  to the floor etc. Simply introduce yourself to the representative as a Chiropractor. Say “I’m with the Chiropractors.” That’s all. The representative will know immediately that Chiropractors are actively working for him/her. There is no need to get into a discussion of the 2 week limit issue or anything else. It’s enough that the legislator recognizes that there is a Chiropractor in the crowd – somebody interested in him/her and who watches what the legislator does – who s/he votes. In most cases they know about our needs. Follow up your personal visit with a letter to their office that speaks to the 2 week limit and the trouble it causes patients. Describe a few cases (or add a few letters written by your patients) and thank them for their time.

    The very best time to “make points” with any legislator is when they need your support and vote – at election time. Because they need your vote they really listen then. Once they are elected we have to rely on personal contact. If they don‘t remember you from when they were running they are harder to approach. So the message is clear: Let’s get involved with the election campaigns as much as you can.

So to sum up, there are three routes to effective political activity:
(1.) intelligent letters on the issue from DC’s across the state – and that should also include letters from patients who have been harmed by the two week limit.
(2) Personal attention to the legislator’s needs (read votes!). Be in the audience when they visit their districts. Introduce yourself as a Chiropractor. If enough DC’s take time to let the legislator know they are in his/her corner it begins to make him/her become more aware of us and our issues. We have neglected this sort of activity (because it’s uncomfortable – we’d rather be home watching TV or playing golf – being in our “comfort zone” as they say). With respect Doctor, it’s time for us to get un-comfortable. It’s time for us to become more personally involved.
(3) Become active in their election campaigns. Visit their local headquarters and offer to work a few hours per week. They really remember that! Why, because hardly anyone does it, that’s why!

Will these initiatives alone make change happen? Not right away, but if we stay at it, the odds increase that that legislator will become more aware of our concerns.

What follows is the text of an email I sent to Gov Scott. You can send an email easily by going to “Governor Rick Scott” in Google and click “Contact Gov. Rick Scott.” You will see the place on the right that allows you to send an email. Below is a copy of what I wrote to Gov. Scott. Feel free to use similar wording. If you wish you can write such a letter to: (I personally believe a hard copy of a letter has a greater effect). Send the same letter to your Legislative Representative. Directions are offered below.

Governor Rick Scott, Executive office Building
400 Monroe St.
Tallahassee, FL 32399

Dear Gov. Scott.

As Chiropractor I am familiar with the pathology that occurs as a result of auto accidents. In most cases the injured party with less than totally incapacitating symptoms is often inclined to “wait for it to get better by itself.” This, of course, usually puts him/her outside the virtually unknown “2 week limit” current law requires to be covered for medical attention as a result of an auto injury. I have seen a patient who, a month after injury and visits to three other doctors (beyond the 2 week limit) who passed her symptoms off  as being a “stiff neck.” My x-rays that showed a broken (fractured) neck that required surgery.

With respect, the two week maximum to see a Doctor (or lose benefits) after an auto accident is simply unfair. Most patients with lingering symptoms, unaware of the two week limit, are routinely left to themselves to stand the expense of treatment. To make matters worse, Major Medical carriers will not cover auto injuries. The injured party is left completely alone in dealing with his/her problems, which could (and often do) last a lifetime.

I respectfully ask that you do what you can to extend that two week limit to at least six months.

Sincerely,

John Gantner DC

**Below is the reply I received from the Governor’s office to the email above. Clearly, these emails make an impact.

Thank you for contacting Governor Rick Scott and sharing your concerns about PIP
Insurance. The Governor appreciates your concerns and asked me to respond on
his behalf. To assist you, I am forwarding your correspondence to the
Department of Financial Services. The Department responds to consumer inquiries
about insurance matters and helps consumers make informed insurance decisions.

If you wish to contact the Department of Financial Services directly, please
use the information provided below. The telephone number is (850) 413-3100, or
toll free within Florida (877) 693-5236. You can also visit the Department’s
website at www.myfloridacfo.com.

Department of Financial Services
200 East Gaines Street
Tallahassee, Florida 32399-0300
Thank you again for contacting the Governor’s office.
Sincerely,
Martha Lynn – Office of Citizen Services
Executive Office of the Governor

There is more: You can write the same letter to Atty General Pam Bondi as well. A hard copy letter is your best approach. Write to her at:
Atty. General Pam Bondi – Office of Atty. General
The Capital PL-01
Tallahassee, FL 32399

While you are at it take time to write the same letter to your county representatives in the FL legislature. You can find your legislator’s office address by going to floridahouseofrepresentatives.com.

Will all this make them change the law? Not right away. Your letters and emails are needed to let the legislators know of the harm this two week limit causes to patients.

No doubt you have a few patients that have been adversely affected (Cheated out of legitimate benefits) by this Draconian two week limit to see a Doctor. Ask them to get behind this effort.

I can guarantee that if we do nothing about this issue that little or nothing will happen. This exercise of writing letters and becoming politically “interested” at the least, is something constructive that stands a chance of helping to put the 2 week issue on the table for re-consideration. This notice is going to thousands of Florida DC’s. Just imagine the power!

Have your staff people and your patients write about this issue. You never know eh?

Get busy Doctor. Along with our patients, we too have a stake in the outcome of these efforts.

john

Below is a letter i sent to My representative in Tallahassee regarding the 2 week limit. Feel free to write a similar letter to your legislators. Every little bit helps.

Florida Practice Sales

John H. Gantner DC, DABCO
Florida Licensed Realtor
1220 SE 19th Lane, Cape Coral, FL 33915
Ph: 239-772-5310 Cell: 239-362-7302 Jgantner@aol.com

Ms. Heather Fitzenhagen, Lee County FL Legislative Representative
2120 Main St. Ste 208
Ft. Myers, FL 33901
4 September, 2015
Hello Ms. Fitzenhagen,

It was a pleasure meeting you at the BUPAC meeting a short while ago. I enjoyed your remarks and was especially grateful for both the photo op and the opportunity to ask you about current law that mandates a loss of benefits if an auto injured person waits more than two weeks to seek medical attention. You indicated that the two week limit was enacted because insurers were concerned with fraud; clearly a valid concern. However, and with respect, like so many issues, it’s rarely a simple matter. The problem of fraud has many sides. I would like to discuss some of them.

I am a 40 year NY Chiropractic practitioner Board Certified in Chiropractic Orthopedics. I was appointed to the 1992 NY State Temporary commission on Workers’ Compensation. As a State Commissioner one gets to see a great deal of what goes on. One quickly becomes familiar with several types of fraud. There is claimant fraud: we often hear about the familiar “slip and fall” accidents and other “staged” injuries. There are also “mills” of doctors who profit by offering less than honest reporting accompanied by more than necessary treatment. Nobody disputes these. Alongside that we have the less than honest doctor who makes a mountain out of a molehill in terms of their reporting; all in an attempt to inflate the bill. As a practicing attorney I’m sure you can agree that each of these scenarios are experienced and that each deserve an intelligent response.

The question we are faced with is twofold: Is the current legislative response to such abuse indeed realistic and secondly, is it fair? The law was crafted and supported by the insurance lobby who sought to solve their (cost) problem, not necessarily those of auto injured individuals. Current law is strictly mechanical. It does nothing to address the plight of injured parties with a clinical problem. It addresses insurers concerns, giving them a mechanical answer to a clinical problem. History shows that insurance lobbies will seek any way, will use any excuse to reduce their exposure (read “save money.”) In pursuit of the carrier’s agenda it is clear that the legitimate rights of more than a few injured parties are often sacrificed.

Given human nature it is not unreasonable to assume that more than a few auto injured parties fail to consult a doctor within two weeks of a legitimate injury, often in spite of real symptomatology. They feel, mistakenly, that “it will go away by itself.” And it is no stretch to assume that more than a few legitimately injured patients are totally unaware of the two week restriction. Any radiologist will tell you that a fresh fracture is sometimes not seen on x-rays taken within a few days of an injury. (X-rays are often taken the day of the injury in most cases. If they show no pathology, which is common, it is assumed there is nothing wrong). It sometimes takes time for an injury as severe as a broken bone to show on x-ray, sometimes more than a few weeks. These individuals are often told by doctors that they have a “soft tissue injury” that will go away with time. Some do, some don’t – and some patients with an injury as severe as a fracture may not become aware of it for many weeks, sometimes months post injury. With respect, a soft tissue injury can be both permanent and responsible for more devastating discomfort than a broken bone or a ruptured disc. Other injuries, such as concussions, may likewise not make their presence felt for many weeks, sometimes months post injury.

In the face of continuing, possibly worsening symptoms even the most conscientious individual will become convinced it may be time to consult a doctor. By then the two week window has closed and they are left without any benefit.

I recall a woman I treated who was told by her family doctor that she had a muscle injury that would go away. X-rays taken the day of injury were negative. My x-rays, taken three months after her auto accident revealed a fracture dislocation of two cervical vertebrae that required serious surgical attention. Two of her neck vertebrae had to be wired together, leaving her with restricted head movement for the rest of her life.

In addition to patient fraud and doctor fraud there is another category that deserves mention: Insurance Carrier fraud. Insurance carriers send injured patients to their “insurance company doctors” for examinations. Carriers rely on the opinions of these doctors – who see the patient only one time – to determine the true extent of the claimant’s injuries. Carriers tend to ignore the reporting of the treating doctor, who sees the patient numerous times, dismissing it as self serving. The record shows that miraculously most everyone these “insurance company doctors” examine either needs no treatment or has reached “maximum medical improvement.” If one probes deeper s/he will discover that many of these “hired guns” are also those who perform examinations and write reports for the least amount of money. As a practicing Attorney I am certain you have witnessed such work – and seen the price an unwitting client has been forced to pay forever, because of such a one sided examination.

Carriers are routinely guilty of using ham fisted initiatives in pursuit of their goal. They dictate their wishes via legislative fiat. They didn’t like the cost of massage therapy so they eliminated it, even though massage therapy is often helpful. They didn’t like the cost of protracted Chiropractic (which treats many chronic symptoms) so they simply limited it to a certain dollar amount. With respect, these legislative requirements have nothing to do with the legitimate necessity of treatment. Viewed accurately, it is easy to see that the insurance lobby is interested only in its agenda – saving money. Clearly, these folks have totally lost sight of their mission.

Insurance carriers increasingly insist on accountability from treating doctors and from patients. Nothing wrong with that. But the carriers are not particularly accountable for their business procedures. Clearly, “Carrier Fraud” needs to be on the table when discussing this issue.

With respect, the two week limit is totally unrealistic, clearly unfair and certainly of harm to more than a few auto inured Florida citizens. Realistically there should be no limit, but a more energetic pursuit of truth in these cases. This is usually quite possible by relying on the reporting of doctors with the most skill. If a limit must be imposed it would seem that at least 6-8 months is far more realistic than two weeks.

Thank you for your time and attention to his matter Ms. Fitzenhagen,