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Wednesday, December 11, 2013

Florida PIP EMERGENCY MEDICAL CONDITION (EMC) Form

EMERGENCY MEDICAL CONDITION (EMC)



For those physicians providing care to Florida patients involved in automobile accidents, this is important information:

THERE IS NO SPECIAL EMC FORM.

1.  The new law states that if the MD, DO, PA, Nurse, or dentist does not notate the patient file that the injured patient has an "emergency medical condition", the patient is limited to only $2500 of the full $10k in PIP insurance that the patient paid for.  

2.  This means that if in the future, the patient requires further medical care including diagnostic imaging, or surgical procedures, the patient will likely be cut off at $2500 from medical care.

3.  There is no rule that says that the EMC must be completed within 14 days.  Only that the first visit to a doctor must be within 14 days.  So, as long as the patient was initially seen within 14 days of his accident, he is covered under his FL PIP coverage.  

4.  If you see the patient and the patient comes in (up to 5 years) post accident beginning Jan 1, 2013, you should still designate the EMC (if the patient's condition warrants it)  in the patient file or you will most likely NOT get your bill paid.

5.  There is no special form for the EMC.  Just document it in the patient's file.  Just write, "medical emergency"  if the patient's condition warrants it.  It is recommended that you state that your decision to write that the patient has an EMC agrees with  one or more of these below:

(a) Serious Jeopardy to the patient health.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.

6.  I am not a lawyer, so my disclaimer to you is that you should contact a PIP litigation lawyer in the state of Florida regarding any legal matter including this one.  

Friday, December 6, 2013

Nelson Mandela, RIP. Dies "peacefully" at 95.

Nelson Mandela, RIP.



One of my favorite Nelson Mandela Quotes.

"In my country we go to prison first and then become President."
Nelson Mandela 

Certainly there are many politicians in FL alone that should be behind bars, starting with the bald skinny guy in Tallahassee.  Honestly, its been a long while since the US has produced a politician who we can be proud of as a country.  We can only hope.  Until then, we have to deal with a bunch of crooks, liars, and greedy dirtbags.

Thursday, November 21, 2013

RESPECT

                                          Respect.


Dr. Alan Himmel

Two Things:

1.  Patients:  Why is respect such a difficult thing for people?  I mean is it too much to ask, that if you cannot make it to an appointment, you call and let the office know?  It takes 30 seconds out of your day.  Thats it. Its just basic consideration.  

2.  Lawyers:  Again, respect.  Its not okay to divert your client away from their treating doctor.  You do not hold a license to practice any kind of medicine.  By making referrals to a health care provider, you are practicing medicine without a license.  You can try any type of lawyering to try and convince me otherwise, but you are wasting your time.

Wednesday, October 23, 2013

FL PIP Statute is upheld in appeals court. EMC stands. Massage and Acupuncture are out.

FL PIP Statute is upheld in appeals court.  EMC stands.  Massage and Acupuncture are out.

Dr.  Alan Himmel

Well, here it is.  Actually it was no big surprise.  The three judges upheld the PIP law.  They say that the plaintiffs did not convince them that denial based on EMC, and the elimination of massage and acupuncture is unconstitutional.

http://www.orlandosentinel.com/news/blogs/political-pulse/sfl-appeals-court-upholds-pip-reforms-20131023,0,7339611.post?track=rss

This was an appellate court ruling.

 You can watch the hearing at:
http://florida-no-fault-pip.blogspot.com/2013/09/video-of-pip-appeal-hearing.html


I am not going to spend a lot of time discussing my thoughts on this, because at this point, it makes no difference anyway.  I am not going to say that the plaintiffs argument was weak and confusing--I'm not a lawyer, so I couldn't have done any better (even though it was weak and confusing); I am not going to complain that the judges already seemed to have made their decision before the hearing even started;   I am not going to suggest that three judges, who were picked by Bush, Crist, and Scott, were going to come up with anything other than the decision that they came up with.

I do have mixed feelings about the fight against the EMC ruling and elimination of massage and acupuncture from reimbursement.  I think that the injunction was a nice solid stepping stone, or transition into the complete repeal of FL pip.  Now that the law has been upheld, its 'possible' that we will have a year or two more before they again try and drive the nails into the coffin of PIP.  It will likely come, but maybe since they got what they want for now, they will leave it alone for a bit.  But, I also believe in the fight.  That's where I am conflicted.  If you don't fight, then whats the point?  In this case, the more you fight, the quicker your death.  Its like you just gotta give them something, or they will come back just to rape and kill you in the end. You just are not going to win in the long or short run.

There will still be PIP suits regarding the PIP, so the attorneys that do PIP litigation will still be needed.  And, thank the lord for these people.  If you are a chiropractor and treating auto trauma patients, you still have some hope that you will see first party insurance payment beyond the $2500, for your hard work.

Later for now.  I have to concentrate on more positive things.




Wednesday, September 18, 2013

VIDEO OF PIP APPEAL HEARING

VIDEO OF FL PIP APPEAL HEARING:  SEPT 17, 2013 

Dr. Alan Himmel

FL PIP Appellate hearing video.  I don't know why the video was cut off before Attorneys Levine and Lirot were allowed to speak.

http://oavideo.1dca.org/OAPlayer.aspx?ID=1307&CaseID=43680&File=131355.smil



Also, please take a look at the what I copied off the court calendar for September 17, 2013.  Take a look at the name on the top of the list for the appellant.  Folks, I see it like this:  If Paul Lambert is on the side of the insurance companies, then he is probably there because he would rather deal with the EMC, than deal with no PIP insurance at all.  Maybe its all over.  Maybe its just a matter of time before PIP is repealed and BI becomes mandatory.  The way I see it, however, I would rather go down with a fight. 

KEVIN M. MCCARTY, IN HIS OFFICIAL CAPACITY, ETC.

Paul Watson Lambert; C. Timothy Gray, A.G.C.; Katherine
E. Giddings, Marcy L. Aldrich of Akerman Senterfitt; James
Bruce Culpepper of Department Of Insurance Reg; Nancy
M. Wallace of Akerman & Senterfitt; Maria Elena Abate,
Matthew C. Scarfone of Colodny, Fass, Talenfeld; Allen C.
Winsor of Deputy Solicitor General; Rachel E Nordby;
Theodore "Ted" E. Karatinos of Holliday, Bomhoff &
Karatinos; Kimberly A. Driggers,

 For Appellant,


- VS - 1D13-1355

ROBIN A. MYERS, D.C., ET AL

Luke Lirot; Jessie L. Harrell of Creed & Gowdy, P.A.; Bryan
S. Gowdy of Creed & Gowdy, P. A.; Adam S. Levine; Mark
S. Sussman,

For Appellee.

15 MINUTES PER SIDE
------------------------------------------------------------------------ -----------------------------------------

Sunday, September 8, 2013

WILL FL PIP SURVIVE? FLORIDA PIP APPELLATE COURT HEARING SEPT 17, 2013

Will FL PIP Survive?


This Tuesday, September 17 2013, attorneys Adam Levine and Luke Lirot will once again be in court fighting for your right to make a living, and for coverage for folks injured in auto accidents.   These guys are working on a very tight budget.  Its time to pony up and give these guys some help.  I made my contribution.  You should make yours.  Don't go complaining when they tighten the noose a little more, and your livelihood affected.  You can help. 

 Donating anything is better than donating nothing.


Taken directly from the site and you can donate at:


FLORIDA PIP APPELLATE COURT HEARING SEPT 17, 2013


This Latest News is Directly from their Website.

SEPT 17th Marks the day once again that Attorneys Luke Lirot and Adam Levine will get to present their oral arguments before the 1st District Court of Appeals to fight for consumers and providers!!

SEPT 17th Hearing 
APPELLATE COURT JUST TODAY ISSUED the ORAL ARGUMENTS HEARING DATE for SEPT 17th!

What does this mean you ask? Here is Attorney Luke Lirot's reply.

Once we make our oral arguments, they take the matter under advisement and they can:
1. Affirm the lower court, in whole or in part, with or without a written opinion.

2. Reverse the lower court, in whole or in part, which would require a written opinion.

3. Ask for more briefing on any issue they think needs more discussion.

There is no time limit for a ruling, but they have indicated that they will administer this case in an "expedited" fashion, which they apparently are, based on the comparatively swift scheduling of this Oral Argument.

If you are reading this and do not get updates on PIP from me, please consider clicking the donate button above and help us out with a donation for our attorneys to continue fighting this cause for all of us! THANK YOU EVER SO MUCH! All donors are then placed on my email update list to receive updates.


It contains all the updates regarding our fight to save PIP and
you can make your donation using a credit card or PayPal

Or, you can mail your donation by check:

United Practitioners Organization Inc.
C/O Vivian Mahoney
740 W. Highland Drive, 
Gatlinburg, TN 37738

Tuesday, August 27, 2013

HAVING A PURPOSE

HAVING A PURPOSE


Dr. Alan Himmel

We all need to keep busy, have a purpose, have goals (big or small),  and have things to look forward to. I think that without goals or a maybe even a prospective finish line, life gets dull and depressing.

I see this a lot in the older crowd.  This is the scenario:  A guy has been working his whole life.  He is now retired.  Suddenly, what seemed like the best thing in the world (not having to work) now begins to affect the man's mental outlook.  Before retirement, he had something to do.  He had a responsibility. He may have been the provider for the family.   He had a function; a purpose.  Now, after retirement, the man's whole dynamic changes. When he was working, he had a specific time to wake up because he had to be at work at a certain time.  He may have had to report to a boss, or maybe had people depending on him as a boss or supervisor.  These are all things that are no long part of his life. The man who used to be busy and have a purpose is now finding that he has nothing to do.  He has no importance.  It's a shot to his ego.

And, I don't believe that the depressed mental attitude that this person feels is entirely a function of boredom, although having nothing to do also gives the man too much free time to think about things like his mortality and aging and other negative thoughts.  Having a purpose will occupy his thoughts, which will naturally displace these negative thoughts.

When you accomplish your goal, or if you find that you now have no purpose, you must find a new one.  Its okay to move on to new things in your life or even switch goals in the middle.  Just as long as you have a purpose at any given time.  In fact, you should expect to move from one purpose to the next, several times over the course of your life.  This is natural.







Friday, August 2, 2013

Lets Get Rid of BI and UM Coverage in Florida.

Lets Get Rid of BI and UM Coverage in Florida.


Dr. Alan Himmel

I love it when a lawyer comes out and says to get rid of PIP.  Sure, Mr. "For the People,"  lets do that. Lets throw the baby out with the bathwater.


http://www.wctv.tv/news/floridanews/headlines/Attorney-Says-Auto-Insurance-Changes-Will-Be-Costly-218003841.html


Why should all the legit people and doctors be penalized for the dirtbags in this state?  This mentality makes no sense to me.  Mr. For the People would like to see PIP go away and instead make BI mandatory.  This sounds good as long as you are a PI lawyer.  As long as HIS livelihood isn't affected its good for HIM. Well I have a family to support and bills to pay.  I don't go on fancy vacations, drive a fancy car, or have my own airplane.  I am just trying to survive.  When I read this from this guy, it just infuriates me.  Maybe he should change his slogan to "For Me."


Crack down on the fraud.  Get the bad people out.   That's the solution.




Saturday, July 27, 2013

One Man's Formula for Success.

WASTEFUL THINKING. WASTED TIME.


I want to tell you about something that happened about 8 months ago while I was at the office working. Like most people these days, I always have my cell phone with me, and this way , I never miss an important call, especially if its a new patient.  So I'm with my patient and my cell phone rings and I excuse myself for a minute to answer.  I answered the usual way I do, which is just my last name by itself.   “Himmel!”  Its strange that over the years I just dropped the Doctor part, and just say my last name. There is actually a story behind that, but I will leave that for another day. So a man’s voice came on with a raspy New York voice and asked me, “Chiropractor?” I answered with an affirmative and, “How can I help you?  This is Dr. Himmel.” He said his name was Mr. Smith (actual name withheld of course).  He said, “I need you to come to my house; my back is hurting very bad.”  I said, “okay Mr. Smith, but would you mind giving me about 30 minutes to speak with you about this?”  I told him I was going to call him back as soon as I'm finished with this patient. He said,”Okay, but don't forget.”  I assured him I wouldn't forget.
So about 30 minutes later I'm finished with my patient I'm actually walking to my car to leave to go to lunch. At the moment I am just getting into my car, the phone rings and it's Mr. Smith. He said really loud, “This is Mr. Smith, you said you would call me back in 30 minutes.  It’s 30 minutes right now, did you forget about me?” I said, “No, Mr. Smith, I was sitting in my car and was about to call you.”   He said, “Okay.  Again my name is Mr. Smith.  I want you to come to my house. My back is hurting me.  You need to help me, please.”  I listened to this man talk and then had to ask him what exactly is going on.   He said again, “My name is Mr. Smith and I'm 94 years old.  He then said, money is no object.  I don’t care what you charge.  Please just come to my house.”  At that moment I heard another voice in the background of a woman.  It was obvious that she was disapproving of the last comment that Mr. Smith said to me, that money is no object.  Again, and not caring, he mentioned to me that he is willing to pay any amount that I charge if i can come right away.  Before I could answer, he tells me to hold and puts the woman on the phone with me, who was there with him. She said that she was Mr. Smith’s personal assistant and he would like me to come to the house and see if you can help him with his back.  I told her to just give me the address and I will come as soon as I finish the last patient at the office.

Once I got the address,  and realized where I was going, I realized this gentleman did not live around the corner from my office.  He lived on Fort Lauderdale Beach, right off the 17th Street Causeway at the end, in a large high rise building overlooking Port Everglades. I had never been to this building before but I knew exactly where it was, because I used to spend a lot of time at the beach when I was younger and I have driven past it dozens of times.   So later that evening when I was finished with my patients, I drove down to this man's house. Actually it was not a house, of course.  He lives on the 7th floor of a condo that overlooks the Atlantic Ocean.   So I Drive all the way over to his place, I park my car in the parking lot, and walk to the lobby of this building. When I got there, I told the security officer that I was going up to see Mr. Smith.  He acknowledged and told me that he was expecting me and directed me to the elevator. So I take the elevator up to the 7th floor, get out, and walk over to the guy’s door and knock. A voice calls out and tells me just to come in. So I open the door and walk in carrying my treatment table and bag.  Sitting in a chair toward the large windows was a man with a big smile on his face. It wasn't a smile on his face that was mocking or arrogant in any way. It was a smile that you get from a gracious person. I put down my table and my bag, I walked over to him, introduced myself, and shook his hand, which I noted was a very strong grip for an old man. He offered me a chair, I sat down, took out a pad and started taking a history.  Again he told me he was 94 years old, but just looking at this man he did not look 94. In fact, he looked more like a man in his 70's. He was not in a wheelchair, he certainly was not in a nursing home; his vision and hearing were good as far as I could tell.  He proceeded to tell me that every morning, especially when waking up, his back was so painful that it would take him over an hour to get out of bed.  He said that the pain would ease up as the day went on. 

He had a lot of vitamins on the counter top. There were several bottles.  In fact there were at least 15 or 20. His personal assistant would create portions that was broken down not only by day, but by AM and PM.  She took care of everything for him. She made him breakfast, she made him lunch, and she made him dinner. She reminded him of every vitamin that he should take and when.  She straightened his house for him and also drove him around to doctor appointments and to the movies.  He loved going to movies.  They would go at least once a week to see a movie.   After the history, I got up, opened up my table, and asked him to have a seat so I can give him an exam. I went through the usual, but noticed one thing interesting, which was the amount of muscle that this man had on his body for being 94 years old.  I commented that for a 94 year old man you're in terrific shape, actually.  At that he then laughed and ask me then why he doesn't  feel like he’s in terrific shape?  I told him you are 94 years old. Anyone who is 94 years old, is bound to have aches and pains and have a good amount of arthritis which generally can give you that stiff and inflexible feeling, especially in the morning.  

He asked me if I could help him.  I never tell a patient that what I'm going to do is remove all of their pain.  Sometimes this happens after one visit, but its not typical, especially for someone advanced in age.  But, the majority of the time what I'm really looking for is simply a decrease in pain of maybe 20 or 30 percent with the first visit. If we get more than 20 or 30 percent reduction in pain, I call it a bonus, and of course it makes me look very good.  Realistically, however, with a 94 year old man I was not expecting too much at all.  So, after the exam, I gave him a very light treatment, which included some stretching and tissue work to the affected area.  I also gave him a very light adjustment, which is actually a joint mobilization technique to get his back moving a little better.  He was very strong and so I didn't even feel that my adjustment was very helpful when I did it.  To make a long story short,  it turned out that the next morning, he was feeling incredibly better.  I wasn't completely surprised, because he actually had me convinced more than normal that I was going to fix him up.  He was very positive in that regard.  His energy was almost overwhelming.  He then asked me if I would be his “captain.”  I asked what do you mean, be your captain? He said he had, “not felt this good in a very long time and I want you on my staff.” Obviously I'm in no position to be a live in doctor. But, I agreed to come and treat him 2 or 3 times a week until we really got his back pain under control.

I think, to be honest, I was more intrigued with this man, than he was with me. Although it was quite a drive to go see him, I would actually look forward to be in this man's company. There was something about him and I wanted to find out what it was.  Those that have gone to chiropractors, know that chiropractors very often spend a lot of time with patients.  Well, at least I do.  Very often, in fact when a patient is on the table not only am i performing adjustments on their spine, and making their back and muscles feel better, but I am also listening to their personal issues and so forth.  I get to know patients on a personal level that I doubt a regular doctor ever will achieve.  This man however, never talked about bad things or problems that was going on in his life. I found it interesting that for a 94 year old guy, not only was he in good  physical shape, but he was also good emotionally, spiritually, and mentally.  He would often talk about ideas that he had for business.  I was fascinated of his positive attitude, and his forward thinking.
One day when I was at his house, I had to ask, “How is it that you have become so successful in your life?  He seemed like he actually enjoyed the conversation that we had, so at this point I did not feel like I was prying or being nosey.  He was actually more than happy to answer. He said to me something, that I still think about almost everyday. This thing that he said has actually helped me cope with problems that I have in my life.  He told me the trick to success is not to worry about the little things. I asked him to elaborate on that. He said that throughout life we are bombarded with things.  Some of these things are good and some of the things are bad and are very stressful.  Some of the things we have to deal with are terrible and even,  devastating. But there are also things that have no bearing on your life in the long run. He said, what most people do is they spend too much time worrying about little things that have really no bearing or things they can't do anything about. He explained that most people spend too much time worrying about things that have passed, like how they would have done things different.  He gave me a few examples of things he doesn't worry about, like getting a parking ticket, or remembering somebody's birthday, or even remembering somebody's phone number.  He said all those things and more are, a waste of time. How he asked, are you able to concentrate on the important things if you are wasting time on the little things?  However, he said to me that you have to make a choice, of what you consider important or something that is not important.  He said unfortunately when you don't worry about the little things like he has done in his life, people get the impression that you are an uncaring person.   He explained that it doesn't make him a bad person if he doesn't keep track of birthdays and anniversaries.  People get upset about it, he said, but you asked me how have I become successful.  This is how it worked for me, he explained.  This is how I lived my life.  He told me that he is as close to his family as anyone else is to their family. He speaks to his children every day and they both live up north in Connecticut.  So, this was Mr. Smith’s little trick.  This is what helped him throughout is life in business.  He eliminated all the little things that he considered insignificant, so he can focus his energy on what he considered the big things.


So, it turns out that this man had a very interesting life. He grew up in a very poor family, up north, in New Jersey. He ran away from home when he was 15 and ever finished high school.  He joined the military eventually and was one of the soldiers who stormed the beach at Normandy.  He showed me photographs in scrapbooks but didn't like talking in detail about it.  When the war was over and he came back to the United States, he was still very broke, but he had a skill that he could carve objects out of wood, or soap.  He said he used to do it only has a hobby but it was his passion.  Since he really loved doing this type of work, he got a job in a factory like most people, but this wasn't enough for him. He wanted to open his own company. So he saved up a small amount of money, and borrowed some more money from other people, and started a company which manufactured candelabras and chandeliers that he designed.  Over the next 25 years he grew his company to the largest American manufacturer of these objects. At one point he had over 4,000 accounts of different department stores and shops around the United States.  He told me that he could have never done this if he spent time worrying about every small issue or little hiccup along the way. He told me the idea is to point your nose in the direction you want to go and don't let anything distract you, like those little things.
Its been a few months since I have spoken or seen Mr. Smith.  But, I have to say that whether he taught me a free lesson, or I just listened to one man’s formula for success, I think the principle of ridding oneself of thoughts that are wasteful, is sound.  
Look at your life.  What do you spend time worrying about?  Do you worry about what someone said? Do you worry about what some other person did or is doing?  Do you exhaust yourself thinking about what you COULD HAVE been?  Could someone write a drama based on your life?
If you answered yes to any of those questions, you are probably holding yourself back and limiting your potential.  Once you decide to free yourself of wasteful thoughts, you will feel like you have much extra time on your hands, and you will be more able to accomplish your goals.  Try it.

Sunday, June 30, 2013

Rotator Cuff Tear: Understanding This Common Occurrence in Personal Injury

Rotator Cuff Tear:  Understanding This Common Occurrence in Personal Injury

Dr. Alan Himmel

Anyone who has ever treated or represented a person with a rotator cuff tear, is fully aware of the troublesome nature of this injury.

But, what do we really know about this traumatic condition?

First, a little anatomy:  The rotator cuff is group of four muscles.  They are the Supraspinatus, Infraspinatus, Teres minor, and Subscapularus.  For purposes of remembering these muscles, just think "SITS."  This is an easy mnemonic, which any student of anatomy should remember.  The names of these muscles, like a lot of structures in the body, often tell a little bit about where they are located within the body.  For example, "supra"-spinatus is located superior to the "spine" of the scapula.  The "infra"-spinatus is located inferior to the "spine" of the scapula.  The "sub"-scapularus is located behind or deep to the scapula.

These muscles, like all skeletal muscles have a function, and they are to move bones by pulling on them, and also help give support to the bony structures of the body. Skeletal muscles must connect to bones in order to be able to pull on them, and they are connected by way of tendons.  The tendon on a muscle is what actually connects the muscle to the bone.  Unlike muscle which can contract and stretch, tendons do not have this ability.  They are simply there to connect the two structures together.  They are generally in-elastic and are very strong.

Notice the white colored tissue?  These are the tendons of the SITS muscles, and these tendons are connecting to the head of the humerus.  They will cause movement as well as to help to stabilize the joint and hold it in place.

The SITS muscles control very specific actions of the shoulder. And, the supraspinatus muscle is of most interest, because its the most commonly injured of the SITS muscles. The supraspinatus controls the action such as raising the arm out to the side (abduction) and turning the arm backward (external rotation). Because of this motion, one can easily see the stress it would be under, by a baseball pitcher, for example.
Abduction and external rotation of shoulder

So, where is the injury?  Where is the "tear?"

Most commonly, the rotator cuff injury is to the supraspinatus tendon.  Again, this tendon connects the supraspinatus (which sits above the spine of the scapula) and connects to the head of the humerus.  And more specifically, its the far end or distal end of the tendon, very close to the humoral head.   There is a small area that is known as the "critical zone" which is an area within the actual tendon that is much less rich in blood supply. This area of hypovascularization is a weak spot on the tendon because it is not supplied by rich blood, to the same extent as other parts of the tendon and muscle are.  It is thought that this is the reason most of the tears occur in that area.



What else can cause a traumatic tear of the supraspinatus besides a sports injury?  Falling on an out stretched arm can cause a tear.(1)  Sometimes when the person falls, the collarbone is fractured or the gleno-humeral joint (shoulder socket) is dislocated at the same time as the tear, although it is not necessary to have a fracture at the same time as the tear.  I have had a few patients over the years who have experienced a fall which resulted in a torn supraspinatus tendon.  In fact, in my personal experience the damage to the tendon is more common in falls than in sports related, or repetitive motion activities.  

The impairment and  treatment are almost always the same.  Usually the patient presents with pain, weakness, los of motion, and swelling in the shoulder.  They tell me they cannot take a gallon of milk out of the refrigerator with the affected shoulder.  Treatment consists of anti inflammatory modalities including icing.  Non steroidal anti-inflammatory medication is suggested.  Strengthening exercises are started.  

The MRI is the diagnostic type that is best suited to definitively diagnose the tear, since the injury is soft tissue in nature.(2)  X-ray very often turns up nothing unless there is a fracture of the humeral head where the tendon attaches, the collar bone is broken, or there is a dislocation.  

Clinical correlation is important.  When did the patient first start feeling the pain?  How was the shoulder prior to the fall?  Did the patient have his arm outstretched at the time of the fall?  All good questions and part of the patient history.

I always suggest the least invasive and safest treatment options for my patients first, but sometimes if strengthening and rehabbing the torn tendon fails, the next step is that the patient tries cortisone injections and unfortunately, surgery may become part of their future.

How this injury will affect the patient in the future is important to document.  The shoulder is never exactly the same as before the tear.  There is always some degree of pain and loss of range of motion.  Frequent exacerbations due to use of the shoulder are common.  Is the patient dominant handed on the side of the injury?  If so, the impairment will be more significant.  Will the injury have any impact on the future income of the patient?  Sometimes this is yet to be determined.

My contact information is:






1.   2013 Feb;29(2):366-76. doi: 10.1016/j.arthro.2012.06.024. Epub 2013 Jan 3.An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears.
Sports Medicine Program, Rush University Medical Center, Chicago, Illinois 60612, USA.


2.   2012 Dec;20(3):361-4.
Non-contrast magnetic resonance imaging for diagnosing shoulder injuries.
Arnold HOrthopaedisch - Unfallchirurgische Praxisklinik, Orrthopaedisches Zentrum Fichtelgebirge, Rehau, Germany.

Thursday, June 13, 2013

Florida PIP No-Fault Blog--This Weeks Search Queries.

Top Search queries which brought people to the Florida PIP No-Fault Blog.

Dr. Alan Himmel

June 13, 2013.  

Q:  Can an 18 year old get only PIP insurance?
A:  No.  The minimum coverage in the State of Florida is PIP and PD.  Everyone must have at least personal injury protection and property damage liability coverage.  

Q:  "EMC doctors in Pembroke Pines Florida"
A:  Right now, the way it stands, the EMC diagnosis may not be needed.  There has been a temporary injunction to parts of the no-fault law.  However, many attorneys are still recommending patients see an MD if there is a need for documenting an emergency medical condition.  The problem is that some insurance companies may try to enforce the EMC rule, and without it, the patient is left with only 1/4 the coverage that was paid for.  To be sure, however, if I were you, I would ask an attorney.  

Q:  "Car accident 14 day treatment"
A:  This person probably wasn't sure, but he heard that PIP treatment must commence by 14 days of an accident.  Correct!  You have 14 days to begin care.  If you went to the hospital, this counts.  Also, your family doctor, chiropractor.  This is one part of the no-fault law that was not contested.  It still stands.

Q:  "Florida EMC form for accidents"
A:  The Florida Department of Financial Services or any insurance company as far as I know have NOT created an EMC form.  I have googled it for months now, and not once have I seen a standard form for the EMC.  Remember, also, the EMC requirement is likely ON HOLD for the time being.  You should check with your attorney on this.

Q:  "Car accident Florida Massage therapy pain"
A:  If you are wondering if massage is covered under PIP, yes, the temporary injunction to the new PIP law is allowing massage like it always has.  However, some lawyers still recommend staying away from massage since there will be a few insurance companies that will try to deny medical claims for massage services.

Q:  "Will PIP pay my medical bills after IME" 
A:  IME stands for independent Medical Exam.  Insurance companies will send claimants to a doctor to get a second opinion.  This almost always means that the patient's coverage will be terminated after the exam, because the IME doctor almost always states that the patient can no longer benefit from care.  I have never let this exam limit my patient's access to treatment if the patient and I think it's needed.  The insurance company will usually send out a letter to the patient which states there is no more coverage, and this very often dissuades the patient from continuing even if they truly need the care.  They are afraid of being stuck with a bill they cannot pay.  Come see me at my office.  954-659-8600 Dr. Himmel

If your benefits are terminated by your insurance company, I have been very successful in getting the treatments paid for anyway.  Just call me.  I will see what I can do.

Wednesday, June 5, 2013

Simple Trick to Get More Money for Your Totaled car.

Negotiating your total loss.


Dr. Alan Himmel

If your car was totalled in a car accident, do you have to accept the first offer that your insurance company makes?  I think not.  Most people do accept the first offer, however, by doing this, they may be leaving a good amount of money on the table that belongs to them.  Over the years, I have helped many patients get more money when their car was deemed a total loss.  You don't need to be a master negotiator, nor do you need to be a lawyer to do this.  There is a trick, and I will tell you how it works:

First, it helps to have some knowledge of the way insurance companies process claims.  I happen to be a licensed public insurance adjuster, aside from being a chiropractor, so I have some first hand knowledge of this procedure.  You have to know that most auto insurance companies process property claims based on what's called Actual Cash Value or ACV.  What this term basically means is that the insurance company will value your property based on what the current market rate is for that particular property.  You just ask yourself, "what would I have to pay right now today, to replace this car?" This little piece of valuable information regarding ACV is written into your policy.  It's in the boring part that most people never read.

Here is an example of the way ACV works:  If you buy a car in 2003 for $20,000, and you file a claim for a total loss of that car in 2013, provided you have coverage, the insurance company will use a system of multiple sources to determine what it would cost to replace that same exact car, now, in 2013.  So, unless you got a banging deal on that car, or its a one of a kind collector's car, most likely the car is worth less than the $20,000 that you paid; the car has to be worth less because of 10 years of depreciation.  Their system will determine what the market price in your area is for that car.

Now, there are a few things to consider here:  You must consider the deductible on the policy.  If you are filing the claim through your own policy, you most likely have a deductible and that would be subtracted from the amount they determine the car is worth.  If you file through the at fault carrier, then there is NO deductible.  The claim is paid at 100%.  Next, the insurance company has to pay you the applicable tax on top of the amount they decide to pay you.



So, here is a breakdown.   Hypothetical numbers:

2003 Car purchased for $20,000.00
2013 Car total loss
2013 ACV of the car is    $4,500.00
Policy deductible  is          $ 500.00
Carrier pays                   $4,000.00
Applicable Tax is               6% (FL) or $240.00

Carrier sends a check for $4240.00

Okay, here is the simple trick that works, in my experience, at least 75% of the time to get more money:  What you simply do is look in as many places as possible including the autotrader, the classified ads, and the flyer and try to find your car with similar mileage and specs, for a higher price than what the insurance company is paying.  You then clip those ads.  Get as many as you can find but if you only find 2 or 3, this may be enough.  Next, you need to forward the ads to the claims adjuster showing that in YOUR market, it would be impossible to replace the car for what they allowed.

Sometimes I have seen that the insurance company is actually very fair with their allowance, and sometimes believe it or not, the insurance company is actually pays more than what it would cost to replace. In either of these cases, just take what they are allowing. (Don't try and negotiate down!)

Like I have said.  About 75% of the time it works out in your favor and you can expect to receive a supplemental check in the mail of sometimes over $1000.

Better in your pocket than theirs.  Good Luck.

Wednesday, May 29, 2013

How to Survive when your car is off the road and sinking in a canal...

If You Find Yourself in a Car and Sinking Fast, You Need to be Aware of This.

Dr. Alan Himmel

In South Florida, it is not uncommon at all for a driver of a vehicle to wind up driving his car into a canal.  Whether this is due to your error as a driver, or another driver's fault,  its highly probable, since there are canals all over the place down here, that you may find yourself in a situation where you are in your car and your car is sinking fast.  As a matter of fact, often times when a person and his car go missing down here, one of the places that the police look, are the canals.  What they do is try and predict where the person was driving, e.g. to work, to church, shopping, and they look straight down using a helicopter or small airplane, and they look for the big black outline of a car in the water.  You definitely don't want to be "found" in your car at the bottom of a lake or canal.

So, the purpose of this article was to give you the necessary information, that if you were to find yourself   in your car and sinking in the water, you would have a chance of surviving.  You actually only have a minute.

I found a good video that explains this.  Its worth watching.  It could possibly save your life one day.
Dr. Gordon Giesbrecht, an expert on submerged vehicles, explains...





And here is another video from ABC news also featuring Dr. Gordon Giesbrecht.


   Unfortunately, you will not be able to practice this survival maneuver.  The first time you try this, is the one time you will be in a car and sinking.  Learn this technique.  It could be a life saver.

Saturday, May 11, 2013

Patient Brokering, Kickbacks, etc. First time in almost 8 years I get a call.

KICKBACKS, PATIENT BROKERING, SOLICITATION...  


Dr. Alan Himmel

I got one of those calls today.  You know, one of THOSE calls.  And, the call came in early on a Saturday morning from an area code that is a few hundred miles north of here.  Naturally, I answered the phone, like I always do, because phone calls to my office are forwarded to my cell phone which sits on my nightstand charging all night.  I never want to miss a call from a patient or a prospective NEW patient.

So, I answer the phone and the he introduces himself and asks me if I am seeing patients today.  I actually had plans to go to the beach, which is where I ultimately ended up anyway, but if someone needed me and it is a new patient, I would actually change my plans, if it was necessary.  Okay, getting back to the phone call:  He had a foreign accent but spoke pretty good english.  He told me there were two patients looking for a doctor to treat their injuries.  My next question to him was, "what type of injuries?"  I actually knew where this was going right from the beginning, but I had to ask.  Believe it or not, I haven't had a call like this in years, or at all, at Miramar Chiropractic.  Well, I haven't had a call like this since I left Dade County, which was about 8 years ago.  I am so glad I am out of there.  Dade County is such a cesspool of horrible insurance companies and desperate people, who seem to have nothing at all to lose.

So he said to me, it was a car accident.  I said, "Sure, I can see the patients; when can they come in?"

 So far so good, right?

He then told me he would like to have the patients come in, but he doesn't want to speak on the phone.  He wants to meet in person to speak privately.  And, he then said he actually has more patients... "about ten more, possibly."

Hmmm.  What to do, what to do?   Lets see.  It's pretty obvious by now what this guy is up to, even though he hasn't come directly out and said anything.  Do I pay a kickback to a guy for patients, which is fraud, is a felony, and would wind me up in prison?  Or, do I tell him to go take a hike?  Easy!  I chose the latter.

For those of you out there (doctors and lawyers, and everyone else) who do this stuff on a daily basis because you think its okay, let me put this into perspective:  First, I have to assume that if you are a professional, like a lawyer or a doctor, you are a fairly intelligent person.  Its not easy to get into professional school, get passing grades, get licensed, etc.  This is something that takes a certain degree of smarts, because if it didn't, everyone would be doing it, and they're not.  Secondly, what I don't understand, and probably never will, is WHY a doctor or a lawyer would risk EVERYTHING by committing fraud, and creating potentially the worse nightmare imaginable when the police come and slap handcuffs on them.  Even though its still wrong, I can see a desperate person, with nothing to lose doing this.  But WHY would a doctor or a lawyer do this?  You know, if every lawyer and doctor would refuse to participate in illegal kickbacks, then the dirtbags on the street who are doing this, would be forced to look for another career and possibly, just possibly, the Florida No-Fault system would be in better shape.  Those of you who are doing this type of non-sense, are responsible for the terrible changes to the no-fault system, and ultimately the repeal, which could happen eventually.  I have a family and bills to pay.  I resent you assholes who are ruining it for me.  I have a big problem with this and yes, I do take it personally, because what you are doing is taking food off my family's plate.

Keep yourself clean.  Refuse this illegal activity, even if you think you will never get caught. You will be able to sleep comfortably at night, and you will not propagate this type of activity, which is pathetic and ruins it for everyone in the long run.

Thursday, April 25, 2013

A day in the life of a Chiropractor in So FL. IME Doctor solicits my patient for treatment at his office.

A day in the life of a Chiropractor in So FL.  IME Doctor solicits my patient for treatment at his office.

Dr.  Alan Himmel

It was an interesting visit I had with a patient today.   Well, actually not a patient, but the patient's father.

This came only a few hours after I had received a call from my patient's insurance company, and was told that the patient's coverage had been terminated because of an IME cutoff.  Those that are not familiar with an IME should know that IME stands for Independent Medical Exam.  The IME is a cute way that insurance companies attempt to limit the amount of benefits that are paid out to medical providers.  They generally use an outside scheduling company who is supposedly not associated with the insurance company.  Its the insurance company's way of dissociating themselves from the doctor who is being paid to essentially cut the benefits off of the policy holder.  This way they can say its an "independent" doctor.

Anyway, so I was speaking with the patient's father who told me that he thought the doctor was a really nice guy.  He was in his early to mid 50's and had a regular office.  By the way, this independent doctor has been terminating the treatment of my patients for the last 10 years.  I told my patient's dad that the IME doctor will always come off as a nice person.  They don't want any confrontation in their office.  They will never give you the results of  the IME in the office, because 98% of the time, its going to be a termination of insurance coverage, and they don't want to get into an argument, or cause any kind of scene at the office.  I always joke with my my patients and tell them that you could be bleeding from the ears, and still, the doctor's job is to say you are okay, and make a recommendation that no more care is either reasonable or necessary.

So, in the conversation with the patient's dad, right after he told me how nice of a guy the doctor was, he tells me that the doctor handed him one of his business cards and told him that they can both come into the office for treatment if they want.  He also told them that he has ultrasound.

Can you believe this?  On one hand, the doctor is being paid to terminate coverage because care is "no longer reasonable or necessary", and on the other hand, he is soliciting the patients for treatment at HIS office.  I am not sure if this even fits into the definition of irony, since to me it seems like this doctor has to be one of the stupidest individuals alive.

I have no choice but to call the insurance company about this matter.  And, I must say that I take no enjoyment in this at all.  I know he is going to deny it, but I feel that its just the right thing to do.  I have to make the insurance company aware of this.

Thursday, April 18, 2013

Florida PIP No-Fault: Do You Have a Career as a Chiropractor?

Florida PIP No-Fault:  Do You Have a Career as a Chiropractor?


Dr. Alan Himmel

Imagine a career in which you spend at least eight years preparing for, between undergraduate and professional school.  Now imagine taking several national board exams and a State Board Exam.  Now, you wait anxiously and with excitement to start your life as a health care provider.

At the end of all this, you are licenced (if you pass the State exam), which by the way means exactly nothing in terms of your ability to pay back student loans, let alone having enough money to eat.

Next, you find out that in your State (the State you decided to be licensed and settle down) there is a never ending fight between the insurance lobby and the health care professionals.  If the insurance lobby wins, you are simply out of a job, and have wasted the last decade of your life, and over a $100,000 in student loans.

I know, I know.  Cash Practice, right?  We don't need insurance... Okay.  Lets get back to planet earth.

You cannot prepare for your future as a chiropractor in Florida.  You cannot comfortably invest the overhead and the expense of an office, or comfortably have a family, a house, etc.

And, people ask me why don't I get myself a nicer car?  After all, you're "a doctor."

I see kids driving new cars all the time.  If a kid can afford it, certainly a doctor can, too.  Well, maybe so.  But the difference is that the 20 year old kid who has just bought a new car, does not have to constantly read the newspaper every day, and worry that his livelihood has been taken away.  Also, he likely does not have the expenses of someone who has just graduated and is trying to get on his feet. He may still have a future, whereas chiropractors in this state, may not have a career, in the long haul.  The 20 year old can more easily plan a future.  A chiropractor in Florida cannot plan ahead, without worrying it could all be taken away.

Interesting that when I graduated almost 18 years ago, I remember doing some "fill in work" for a DC who was going out on a seminar.  He had been practicing a very long time--maybe like 30 years or more.  He is long retired at this point.  He said to me, and I will never forget:  "I feel sorry for whoever is coming into this profession at this time."

I didn't know exactly what he meant.  He had a busy and thriving practice.  What could be so bad?

I think that the big deal for chiropractors in Florida is the uncertainty.

Tuesday, April 2, 2013

PIP Injunction. Affidavit and/or Donations Needed Now! Florida PIP Defense Fund.


PIP Injunction. Affidavit and/or Donations Needed Now!  Florida PIP Defense Fund.

Help Save Florida PIP


As you are aware by now, the Mr. Lirot and Mr. Levine have been fighting to keep the Florida No-Fault Law in place for Florida residents and providers.  click:  FLORIDA PIP DEFENSE  They need these affidavits filled out and sent in.  They also need money.  But, if you cant send money, you can at least file an affidavit explaining how the changes in PIP will affect your livelihood.  Below are the Affidavits. There are instructions below as well, including where to send your donation and affidavit.


Below is the affidavit for Florida Providers: Print this form out. Follow the instructions (below) on how to fill it out properly and where to mail it. Here is the link to the PDF: 



UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

TAMPA DIVISION

ROBIN A. MYERS, A.P., an individual
person and Acupuncture Physician,

GREGORY S. ZWIRN, D.C., an individual
persona and Chiropractic Physician,

SHERRY L. SMITH, L.M.T., an individual
person and Licensed Massage Therapist, Case No. 8:12-cv-2660-T-26TBM

CARRIE C. DAMASKA, L.M.T., an individual
person and Licensed Massage Therapist,

“JOHN DOE,” on behalf of all similary
situated health care providers,

“JANE DOE,” on behalf of all those injured
by motor vehicle collisions,

Plaintiffs,

v.

KEVIN N. McCARTY, in his Official Capacity as
Commissioner of the Florida Office of Insurance
Regulation,

Defendant.
__________________________________________/

AFFIDAVIT OF  ______________[INSERT YOUR NAME HERE]_______________

STATE OF FLORIDA )
COUNTY OF [FILL IN COUNTY] )

Before me, the undersigned authority, appeared    [YOUR NAME HERE], having been duly identified and who states under oath the following:

  1. I am over the age of 18 years and otherwise competent to make this affidavit;
  2. I have personal knowledge of the facts set forth herein;
  3. I am a resident of  [FILL IN COUNTY] County;
  4. I am a [INSERT TYPE OF HEALTH CARE PROVIDER OR PATIENT];
  5. I own [OR WORK IN OR WHATEVER - INSERT THE BUSINESS NAME];
  6. My business is located in [INSERT COUNTY HERE] County;
  7. I possess license number [INSERT LICENSE NUMBER HERE] issued by the State of Florida to practice [INSERT TYPE OF LICENSE HERE];
  8. I read the 2012 Motor Vehicle Personal Injury Protection Insurance Act;
  9. Although I [UNDERSTAND, AM CONFUSED BY ETC.] the aforementioned Act, I believe that the Act will [what you think the Act will do in your own words. Generally injunctions are granted for things that will cause you irreparable harm – i.e. even if they could give you money, you would still be harmed because your business was destroyed etc.  With an injunction, you are asking the Court to provide you with an extraordinary remedy – something that will potentially cause you such harm that you will be permanently damaged.];
  10. At this time, this Act has already  [what was the impact of the act on your business?];
  11. Further, I have the following comments:
  12. I am requesting that this Court maintain the status quo so that I am not irreparably harmed until the Court can proceed with a full hearing or trial regarding this matter.

FURTHER AFFIANT SAYETH NAUGHT.
_______________________________________________
[INSERT YOUR NAME AND SIGN ABOVE]

NOTARY ACKNOWLEDGMENT

The foregoing Affidavit was sworn and acknowledged before me on this ___th day of _____________________ 2012 by  [INSERT NAME HERE], ___who is personally known to me, or ___ who produced the following identification: __________________________________________.

Notary signature: ________________________________
Notary name: ________________________________
Notary Expiration Date: ____________________________
Notary Seal:

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Below is the Affidavit of you are a Florida Consumer: Copy and print this form out. Follow the instructions on where to mail it. Here is the link to the PDF:  

Click here for the Affidavit if you are a Florida Consumer




IN THE CIRCUIT COURT OF THE SECOND JUDICIAL CIRCUIT

IN AND FOR LEON COUNTY, STATE OF FLORIDA

CIVIL DIVISION

ROBIN A. MYERS, A.P., an individual person 

and Acupuncture Physician, GREGORY S. 

ZWIRN, D.C., an individual person and
Chiropractic Physician, SHERRY L . SMITH, L.M.T.,
an individual person and Licensed Massage Therapist,
CARRIE C. DAMASKA, L.M.T., an individual 
person and Licensed Massage Therapist, “John Doe,”
on behalf of all similarly situated health care providers, 
and “Jane Doe,” on behalf of all those individuals 
injured by motor vehicle collisions,
Plaintiffs,
Case: 2013-CA-000073
v.
KEVIN N. McCARTY, in his Official Capacity as
Commissioner of the Florida Office of Insurance 
Regulation,
Defendant.
_____________________________________________/
AFFIDAVIT OF: ___________________________________
STATE OF FLORIDA
COUNTY OF _____________________
Before me, the undersigned authority, appeared ______________________________, having 
been duly identified and who states under oath the following:
1. I am over the age of 18 years and otherwise competent to make this affidavit;
2. I have personal knowledge of the facts set forth herein;
3. I am a resident of ______________ County;
4. I am a resident of Florida that owns a motor vehicle and is required to purchase 
$10,000.00 (ten thousand dollars) in Personal Injury Protection Insurance. My address:
_____________________________________________________________________.

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Here are the instructions to fill out the Affidavits and here is the PDF:


AFFIDAVIT INSTRUCTIONS: 1. Tell the truth. 2. Add your name to the title: Affidavit of: Your Name. 3. Add your current County 4. Add your name to the first line, Before me…. 5. Fill in line #4 with your county of residence (where you live) 6. Fill in line #4 with your licensure: DC, LMT, AP, Consumer 7. Fill in line #5 with your business name 8. Fill in line #6 with the county your business is located in. 9. Fill in lines #7 and #8 with the impact of the 2012 PIP Act on you and your business – be as detailed as possible. An injunction is an extraordinary remedy – it is hard to get. We have to show that you and your business are being irreparably harmed – irreparable harms occur when you cannot receive mere money to make things right – things like loss of referrals, loss of patient relationship etc. Also list financial harms – all of them. 10. Fill in #10 – the state alleged that eliminating acupuncture and massage were ok because they are of no benefit. 11. Fill in #12 with any statement you wish to make. 12. If you have any accident victims that were injured before or after 1/1/13 and have been limited in their coverage, please have them fill out an affidavit too and discuss how they have been impacted by this Act. INSTRUCCIONES EN COMO LLENAR EL AFIDAVIT: (Favor de Leer todo, antes de llenar el Affidávit.) 1. Diga la verdad. 2. Agregue su nombre al título: Declaración Jurada de: Su Nombre. 3. Añada su condado actual 4. Añade tu nombre a la primera línea, delante de mí .... 5. Introduzca la línea # 4 con su condado de residencia (donde vive) 6. Introduzca la línea # 4 con su licencia: DC, LMT, AP, Consumer 7. Introduzca la línea # 5 con su nombre comercial 8. Introduzca la línea # 6 con el condado de su negocio se encuentra en 9. Llene las líneas # 7 y # 8 con el impacto de la Ley de 2012 sobre PIP de usted y su negocio - sea lo más detallado posible. Una orden judicial es un recurso extraordinario - es difícil de conseguir. Tenemos que demostrar que usted y su negocio se están irreparablemente dañados - daños irreparables ocurren cuando no se puede recibir dinero solo hacer las cosas bien - cosas como la pérdida de referencias, la pérdida de la relación médico-paciente, etc. también una lista de los daños financieros - todos ellos. 10. Rellene # 10 - el Estado alega que eliminando la acupuntura y el masaje esta bien porque ellos no son beneficiosos al accidentado. 11. Rellene # 12 con cualquier declaración que usted desea hacer. 12. Si tiene alguna víctimas de accidentes que resultaron heridos antes o después de 1/1/13 y se han limitado en su cobertura, por favor haga que llenar una declaración jurada también y discutir la forma en que se han visto afectadas por esta ley.