There are other times, however, when it just seems
like a good idea to have a radiologist’s report in your file when you
are dealing with any kind of a contested case, such as a personal injury
case or a workers’ comp case. Here
are two points that could possibly be important for those types of
consultation referrals:
1. Make Sure Your Paperwork is in
Order
The request/referral form that you send to your
chiropractic radiologist with your x-rays becomes a part of the
radiologist’s chart on that patient.
Copies of the radiologist’s records are frequently requested by
insurance companies and attorneys, or they may be subpoenaed.
You therefore need to think about what you write on your
consultation referral form. You
want to make sure that the logical clinical reason you have for sending
the x-rays for a second opinion is written on the form, showing that you
have a good reason to send the x-rays for consultation.
To write down “P-I case” as the reason for sending the films
is obviously not compelling to people who later scrutinize these things!
In contrast, many clinically-relevant reasons do exist in
personal injury cases that may call for a second opinion, examples
being:
If these or similar clinical questions exist, make
sure they are written on the request/referral form.
2. Watch Your Timing
Even the timing of submitting the study has sometimes
been challenged by an insurance company, particularly if the case later
goes on to arbitration or trial. If
a doctor submits the x-rays reasonably close to the time that they were
taken, it seems clear that the consultation was needed for some
clinically-relevant reason (and was therefore “medically
necessary”).
If the consultation is requested later in the
progress of a case, there should then be a reason indicated for that
delay, such as “delayed response to treatment.”
Otherwise, submitting a case for consultation after treatment has
been ongoing for awhile can give the impression that the radiologic data
was not needed to facilitate patient treatment and that the consultation
was obtained purely for documentation reasons rather than to enhance
patient care.
As
a separate issue, documentation can also certainly be another
good reason to submit a case for consultation, but it then becomes a
litigation-related expense rather than a health care expense.
Naturally, insurance companies are contractually obligated to pay
only reasonable and necessary health care expenses, and they therefore
rightfully refuse to pay for litigation-related documentation.
Attorneys, on the other hand, may be particularly interested in
documentation-related consultations and may therefore be willing to
request and pay for whatever documentation they might feel provides
value to their case. Just
keep in mind the difference between the two scenarios.
Observing
these pointers can help you avoid some unpleasant surprises.
