The Insurance Carriers Are Not Your Adversaries

The Insurance Carriers Are Not Your Adversaries

The Insurance Carriers Are Not Your Adversaries

In this article what we want to cover today is the area of your relationship with insurance carriers. In personal injury work, insurance carriers are not your adversaries. In fact, just the opposite can be true.

You can have great relationships with these insurance companies when you are working in the personal injury realm.

What does a productive, healthy, and great relationship look like with these companies?

It means that you have a smooth billing process. You bill them fairly and accurately and they pay you for the services your render. It’s as simple as that.

Let me illustrate how I came to this conclusion. Most of us know that in the personal injury area, you feel like you are constantly fighting with insurance carriers over billing and payments. I was no different. For the longest time, I just thought that is the way that things work.

Then after I’d been in private practice for around year 8, 9, or 10 of my 17 years running my own practice I had one of those “a-ha” moments.

My awakening if you will, was when I realized that these insurance carriers were paying for everything that I had. These companies really wanted the same thing I wanted as a doctor with my personal injury patients.

Let talk about that for a minute.

What Did I Want as A Doctor?

First, I wanted to treat a lot of injury patients. I wanted to build a successful practice. I knew that to do this I needed to get good physical results for injury patients. As you know, if you’re getting these kinds of results in the injury market today, you understand diagnosis. That is something worth noting. If you do not understand the critical role of diagnosis, I’ve written some pieces on that subject that you need to check out.

Now in the area of spinal ligament injury diagnosis, we know as a fact, that there is a shortage of doctors who can do an effective spinal ligament injury workup. We can accept that as true.

How do we know this?

Just look at the statistics in the injury market today. If you do a little research, you quickly learn that around 50 percent of auto accident injury patients never fully recover. What’s worse is that 30 percent of them have significant life changing disabilities resulting from these injuries.

This information helps form the picture of what these insurance carriers want in the personal injury market. In fact, if we’re keeping it simple. The insurance company is after the same thing that the patient wants, the same thing that the lawyers want.

They are all looking for a doctor that understand how to diagnose all these injuries.

They want a doctor who doesn’t miss injuries, one that can tell the difference between a disc herniation and a non-disc ligament injury. They all need someone who knows how to image these injuries using a digital X-ray and how to work it up.

They are looking for a doctor who can clinically correlate for a motor sensory or pain problem at the injured area. Above all they are looking for a doctor who can treat the injury and affect a good result.

And as a caring doctor, isn’t that what we want as well?

Let’s Talk About What A ‘Good Result’ Means.

A good result means that we get a result that minimizes the risk of long-term complaints. Put plainly, we want the patient to fully recover, this means no:


  • Residual symptoms of any kind
  • Deficits in activities of daily living
  • Interference with the ability to hold a job and earn a living

A doctor that can do this, is sought after in the market. They are the ones who diagnose these injuries quickly and accurately. They jump on the treatment plan right away to minimize the pain and suffering of these patients.

We Really Aren’t Adversaries, Are We?

So, if that is what doctors want and insurance companies want the same thing, it’s hard to view this as a hostile relationship.

The problem is that this is not the results that most insurance companies are routinely experiencing in the injury market today.

That is what doctors like me are trying to change. We produce doctors who can deliver this to the carriers through our SmartInjuryDoctors®Program.

This is going to be the big emphasis as the market moves forward. By 2020 and beyond the market is not going to tolerate ineffective doctors and patients without results.

The market will dictate that these doctors better get physical injury results. As a doctor operating in this area, you must adapt to avoid hardships and poor relationships with the insurance carriers.

Insurance Carriers Will Actually Look for You.

Insurance companies are smart companies. They are always looking to be more efficient. They will start to profile the doctors who get results for injured patients and provide a minimal amount of hassles.

They will begin to say, “Okay, great here’s a doctor who is actually doing an excellent job. The documentation is solid. The diagnosis is solid. And there is no over-utilization of procedures. There’s no stacking of procedures. This is a doctor we want to work with.”

They are looking for a logical progression that has strong outcome assessment procedures that determine a patient’s progress. They are looking for a doctor who knows when the maximum medical improvement has been reached and states that further treatment is not indicated.

These are the types of doctors who are going to survive this shift.

Who Has Problems with Insurance Carriers?

So, let’s go through what types of doctors are having trouble with insurance carriers. Generally speaking, there are three things that cause the relationship to turn adversarial.

1.      Poor diagnosis

2.      Treatment without results or improvement

3.      Documentation that lacks information

It doesn’t matter if you are an orthopedic doctor, a physical therapist, or a chiropractic doctor. The insurance company is looking for those three critical elements.

From their point of view, this is a straight forward easy thing to do.

Here is what they want to know:

  • They want to know what the injuries are.
  • Are these injuries permanent?
  • How did you determine if they are permanent?
  • Is there lasting pain or discomfort to the patient?
  • Can the patient no longer perform their job?
  • Have they lost the ability to enjoy an area of their life?

Let me give you an example to illustrate what they want to know.

Say you have a patient who had a low back injury. Now, you’ve diagnosed it correctly, that’s step one. You make the determination that this is a permanent injury. They can return to work, but they do have a loss of enjoyment. They used to enjoy a 5- or 10-mile bike ride every weekend, but now they cannot even get on the bike. That is what they mean when they refer to a loss from enjoyment of life factor.

It Comes Down to Documentation.

You need to supply the documentation that explains all this in a way that makes sense to the insurance carrier. A lot of doctors just do not realize what the factors are that an insurer needs to cover.

Take a minute and put yourself in their position. If you were paying the bill you would want the answers to these questions. Treat the carriers how you would expect to be treated and you know what? These insurers are going to treat you well. It’s just this simple.

By understanding this, you are going to quickly realize that documentation in the personal injury space is probably the simplest documentation that there is.

Adversarial Relationships Are Futile

There is no practical reason to be at odds with an insurance carrier. It serves no practical purpose. If you want to constantly be arguing, if you actually enjoy arguing, if your one of these doctors who sees themselves as the only expert. Sort of an expert witness type, all the time. You’re going to find things are difficult.

My advice? Stop Practicing That Way

Most doctors do not want to waste a bunch of their time every day arguing with insurance companies on the phone. They really don’t. They want to have a fair, productive relationship. We’ve told you what you need to do to achieve that. It is something that I am really passionate about. I teach it all day everyday with my SmartInjuryDoctors® Program.

To be successful in this area, you need to document in such an easy and simple fashion. You must make it easy for everyone who’s making a benefit determination to know what’s going on. This is going to improve your relationships with all involved not just the carriers.

If you can do this, it will be easy for you to stand out in the market. It’s not what they’re used to. So, remember the three things that we preach here:

1.      Diagnose completely, accurately, and effectively

2.      Treat patients in a way that produces results and fives them relief.

3.      Document in a way that tells everyone what is going on with each patient

Our most successful doctors are the ones who understand that it’s neglecting even tiny little things in these three areas that can cause friction. Friction that is easy to eliminate by just correcting a few simple things.

For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

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