New York Workers Compensation Critical Update: Part 4

US Chiropractic Directory

from the desk of:

Mark Studin DC, FASBE(C), DAAPM, DAAMLP

"NYS WC Critical Update, Part 4"

No Fault and WC Carriers Not Following the New Fee Schedule

Disclaimer: This opinion does not reflect any organization, including, but not limited to, the US Chiropractic Director or any state or national organization. It is the sole opinion of Dr. Mark Studin and is intended to be a tutorial for the new NYS WC Guidelines. Each doctor has to base his/her utilization of the guidelines, codes and treatment plans based upon the clinical findings of his/her individual patients.

Although no fault and workers compensation have a completely different set of regulations, I am making the same recommendation if any carrier does not follow the new fee schedule. Download directly from the New York State Insurance Department's Web site a complaint form (http://www.ins.state.ny.us/acrobat/compl.pdf) and render a formal complain to the Insurance Department. The carriers will start getting profiled and in many instances, fined by the Department of Insurance for not following the regulations. In addition, you will get a ruling from the Department of Insurance mandating the carriers pay you according to regulation. Right now they are banking on you being naive. Take action to get paid. In any scenario you choose below, this is a mandatory step.

Should the WC carrier not pay in accordance with the new guidelines, file an immediate HP1 (http://www.wcb.state.ny.us/content/main/hcpp/hp1instructions.jsp) as this is cause for an immediate award to the doctor. I would suggest filing complaints and an HP1 simultaneously. If you want to take another next step, you could also file an online fraud complaint against the carrier. Unfortunately, the carriers are the only players that do not have an area to render an online complaint against. You can only complain against the patients, the employer or the doctor, not the carrier. I would render a complaint against the employer and then make a note in the online area that the carrier is infracting the regulation. Perhaps this way the employers will get involved to ensure that their insurers are playing by the rules as this is an automated system. Employer Fraud Referral Form (https://albany33nt.wcb.state.ny.us/igfraud.nsf?OpenDatabase) If you are really angry, you may also report fraud to the Inspector General's Fraud Hotline, phone: 1-888-363-6001/518-473-4839, fax: 518-402-1059.

You can choose to do all 4 steps against the WC carriers simultaneously or pick and choose what suits you best. If it was me, I would do everything in my legal rights to enact a fair playing field as the system has been stacked against me for too long. The only choice that you do not have is to do nothing as you will not collect fees for services performed and the carrier will just get richer laughing all the way to the bank at your expense.