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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.