Medical Providers are without a Voice

Tuesday, January 31, 2012 | 0

Over and over again, we hear that liens are a problem at the Workers' Compensation Appeals Board and the solution appears to be to make rules and regulations that would either discourage medical providers from seeking reimbursement or dismissal of their bills altogether. The writers of this short article primarily represent hospitals.
  
When we read these articles that state liens /medical providers/lien representatives are the problem for the backlog of lien filings, we can’t help but wonder where are the voices of medical providers?

Where is it mentioned that when insurance companies will not discuss a medical provider's bill that has been underpaid unless a lien is filed, that this causes unnecessary lien filing?

Where is it mentioned in any of these articles that when the California Insurance Guarantee Association refuses to pay a medical provider because they are represented by a collection company, causing liens to be filed, that this is a problem?

Where is it mentioned that the State Compensation Insurance Fund refuses to pay every provider unless it receives proof of license, no matter how many times they were served a business license, causing excessive lien filings?

Where is it mentioned, when bill review companies purchase and sell preferred provider organization discounts for a fee, that this causes a backlog of lien filings?

Where is it mentioned that when a case is settled with a “Thomas Finding” in order to reduce the medical bills, that this causes lien filings backlogs?

Where is it mentioned that defense attorneys continue to get continuances at the WCAB stating they need more discovery when the issue is fee schedule, causing a backlog of lien filings?

Where is it mentioned that defense attorneys file petitions for sanctions for no reason except that the medical provider filed a lien to get paid fee schedule, causing additional hearings?

And where is it mentioned that defendants are refusing to hear or negotiate a lien at a case-in-chief hearing, causing more liens to be filed?

The list is not complete or all inclusive, and over the years none of the above issues have been addressed to stop the backlog of liens. Although we know every so often the defense attorneys or insurance companies routinely come up with different methods not to pay liens, causing more filing of liens, this continual circle of not paying medical providers is not stopping. Just as one is overcome, then the insurance companies come up with another reason to stall and or not pay medical providers.

In addition, we have yet to see any regulations regarding bill review companies, as their main function is to pay medical providers the least amount as possible that’s how they get paid, thus creating questionable unregulated conduct which leads to the lien backlog. But yet we fail to see any of these issues articulated in articles, or regulations adopted and or proposed regulations. We need to look at the true cause of the backlog of lien filings if the WCAB truly wants a solution.

It has never been in the medical providers’ best interest to go to court, and the more times they are required to go to court the more money they lose. While the same is not true for defense attorneys, as they are billing by the hour, so the question is who is really causing the backlog of liens, and why it will never change because the articles and laws are looking at the wrong causes.
 
It is these writers' opinion that if lien claimants were treated more fairly by the courts as well as the insurance companies and not a “burden,” but by being put on equal footing, liens would be handled more quickly.

The real issue is that the state mandates a fee schedule and if the payers paid the fee schedule instead of finding methods to avoid paying, here may be a drastic reduction of liens being filed.

Reid L. Steinfeld is house counsel for Grant & Weber, a collection agency in Calabasas, Calif. Richard J. Boggan is also an employee of the firm.