Why I Won't Do CA Comp Anymore

Saturday, April 8, 2006 | 0

By York McGavin

My company operates in about 38 States, and in each and every state, we are 'non-participating' providers. I have declined more than a few offers to join an MPN, and will continue to do so. In fact, my company stopped accepting new IW referrals as of 1/1/05.

The cost of doing business here in California would drive me out of business if I continued accepting new referrals. I'm a small dollar lien claimant. My highest billing is under $2,000.00.

Prior to SB 228, my company could survive by being paid on the accepted injury cases, and carry the float on denied injury cases until the case-in-chief resolved. Effective 1/1/04, the payor communits simply stopped paying for treatment on the accepted injury (chronic) cases already being treated, on the basis "ACOEM does not support this treatment per the acute/subacute Chapter xx, page yyy."

This meant that reimbursment was being denied across-the-board, causing my company to carry my entire IW load on a float.

Next, effective 1/1/04, per SB 228, the lien filing fee was born. Now, in addition to not being paid on current treatment, I had to pay $100.00 for the privilege of filing a lien in order to obtain my day in court. Swell. To date, I have paid between $140,000.00 - $160,000.00 just in filing fees.

Once the $100.00 lien filing fee was paid, I was granted the privilege of being required to attend each and every MSC, which usually were continued, sometimes a trial on the case-in-chief (where my lien could have been litigated along with the case-in-chief, but the WCJ chooses to always bifurcate my lien to a lien conference on accepted injury cases --- but not in those rare AOE/COE denied cases where I argue against bifurcation because that trial may be my only bite at the apple.), a status (lien) conference, which is usually continued to the failure of the defendant to serve me medicals requested many many times, then if no resolution, the matter is continued to a lien trial, which is usually bumped to another date because of an expedited hearing, continued testimony case-in-chief trial, or a case-in-chief trial. Oftentimes the lien trial date will get bumped numerous times. My highest count is four.

In order to make all these appearances, I have had to hire a number of proficient hearing reps, all of who are either a J.D., a paralegal, or an attorney. I currently pay between $300,000.00 - $400,000.00 per year to maintain this representation --- all of which is necessary, for oftentimes, we are noticed to make 9 different appearances in 7 venues, just on any particular morning.

If we fail to appear, we risk having our lien disallowed. Yes, I know that I can send in correspondence indicating nobody can appear, but our lien can be resolved by calling (800) 123-4567. Whenever I have done that, I receive a 10 cents on the dollar offer. Factor in the hard costs of doing business, combined with the delays inherent in finally obtaining reimbursement after the case-in-chief settles, 2, 3, 4, or 5 years down the road, and it should be easy to understand why I chose to drop out. The longer I remained a provider facing the above obstacles, the quicker I was headed out-of-business.

Now, to join an MPN, I am allowed the privilege of allowing my services to be discounted below OMFS, in the vast majority of instances, as the incentive to be allowed to enter the MPN system. Most contracts forbid filing a lien if the ER chooses to not reimburse me.

Accordingly, yes, I "refuse to be on MPNs"

By York McGavin. York can be contacted at ymcgavin@socal.rr.com

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