How to Properly Manage a Personal Injury Patient

Proper management of an injury patient is an important part of patient care that should not be overlooked.  When a new patient comes into my office, I always make sure that the patient has a clear understanding of the process.

The procedure involves detailed documentation of the patient's history, which includes finding out about prior injuries, car accidents, prior medical treatment for any body part, even if the treated body part was not accident related.  The reason behind this, is that all parties involved will want to know whether the patient's new injury overlaps with any prior medically treated areas of the patient's body.

Moreover, included in the history are any other medical conditions, as well as family history, and prescriptions currently being taken.  From this, you can learn a lot.  For example, a patient recently told me that she has a family history of aneurysm resulting in death to her sister and father. Chiropractors should never overlook this history, and blatantly do cervical adjustments on these types of patients.

At the end of the initial visit, there should be an initial report written and each subsequent visit with the doctor should be documented in standard SOAP form.  The patient always signs the chart note for the visit.  No signature and no visit ever happened.

I almost always make sure the patient is quickly referred to an orthopedic specialist or his medical doctor who could also diagnose emergency medical condition if necessary.  Emergency medical condition or EMC, is specific to Florida, and is required if the patient has a more serious injury, and its purpose is that it frees up the patient's full insurance benefit, if extensive treatment is necessary.  The insurance company is counting on the fact that the patient will not have an EMC and will only be responsible for 25% of the claim.  Without it, the insurance company takes away 75% of the patents insurance benefit.

Soft tissue injuries are better diagnosed with objective tests, like MRI.  Sometimes, X-rays are ordered if fracture or dislocation is suspected.  Most of the time however, x-rays do not turn up injury in patients that have injuries that are soft tissue in nature.  Over the years, I have seen some broken ribs, sternums, and bones in the hands and feet, but this is rare.  X-rays have shown dislocations, over the years,

Depending on the frequency of the visit, the course of treatment can vary between a couple months and upward of 6 months or more.

Any other referrals will be made if necessary, including orthopedic doctors, neurologists, podiatrists, mental health doctors, etc.

Finally, a report is generated when the patient is released from standard care, at maximum medical improvement, MMI.  If there is a request for an impairment rating, I will provide the rating in the report, and forward the report to the attorney who is helping to resolve any claims.

During this whole process, COMMUNICATION is key so that everyone is on the same page, and nothing is missed.

I have been seeing mainly personal injury type patients for 20+ years.  If you have been involved in a car accident, don't hesitate.  Please call my office to schedule your first visit.  If you are a lawyer and have a client who you think could benefit from an experienced doctor in regard to accident care, I will love to see that person.  It is NOT my goal to provide GOOD care to my patients;  it IS my goal to provide EXCELLENT care to my patients.

Alan Himmel, DC PA.
954-659-8600

"I WANT MONEY," is not the Right Message to Send to an Insurance Company.

I WANT MONEY

The Statute of Limitations for filing suit in a personal injury case in Florida is 4 Years.  However, in the same state, here in Florida, there is a 14 DAY limit to wait, to begin treatment, after a car accident.

Think about this for a second, please.  You will see the point I am trying to make.   WHY?  Why would you first seek an attorney before a doctor?  You are injured, RIGHT?

Do you know what kind of a message that this sends to an insurance company?

PLEASE DON'T DO THIS!   You have 4 WHOLE YEARS to get the paperwork in with an attorney and file against an insurance company. This is 4 years!  The law is very clear on this topic.

And, it's very clear on this also:  You only have 14 DAYS to get under care for an auto accident in Florida.  ONLY 14 days.  And, it goes by very quick.  Injured car accident patients SHOULD seek treatment right away.  And, when you seek treatment right away, you send an entirely different message to the insurance company.

The message that you send when you seek treatment first, is "I am injured."
The message that you send when you seek an attorney first, is "I want Money."

I have been treating car accident patients for 20+ years.  I know the rules and the laws, and have a lot of experience with this.  You can contact me and I will personally explain this to you, or better yet, call me and set up your appointment.

Alan Himmel, DC PA
954-659-8600--Call me directly.

Is there such thing as a Florida PIP No-Fault Insurance Provider?

What is a Florida PIP No-Fault Insurance Provider?

Miramar Chiropractor Accident Doctor

Can a doctor be a provider of PIP No Fault Insurance?  I know there are Blue Cross Blue Shield providers, and Aetna, and Humana, for example. But what about PIP?  I say, yes.

We are a Florida No Fault PIP Provider.  I say this as IF it requires a special designation or certification to see car accident patients and communicate with PIP carriers for reimbursement.  Well, of course it turns out that it does NOT take any special certification to this.  So, why do I call myself a Florida PIP No-Fault Provider?  It is because over the years I have met many doctors, yes, chiropractors as well, who do not handle these types of patients.  When asked why, do you know what the number one reason was?  It is that they don't know how to do it, and they never get paid.  This usually results in the doctor chasing the patient around for payment.  It means sending several bills to a patient and then collections, and it usually ends up a total waste of time.  The doctor's office loses, and of course, the patient loses as well.

I have actually gotten several patients over the last 20 years because when they went to their regular doctor, they were told, "Sorry, we don't take accident patients."  That's when they were referred to me for care, and I handled not only the communication and payment from the proper insurance carrier, but also handled the intricate documentation and proper referrals that are often times needed throughout the period of care of the patient.  This is not to mention the writing of a very detailed report which outlines the details of the accident, the injuries, the diagnosis, prognosis, future costs of health care, possible loss of work which will cost the patient income in the future.

Knowing what I know, and what I have seen over the years, I would encourage anyone who has been injured in a car accident to make sure they go to a provider who is experienced and knowledgeable on dealing with PIP.  It is entirely different than HMO or PPO or medicare rules.  PIP billing, in a sense, is a specialty.  It is not well taught in billing and coding schools, and you would not expect an average insurance biller or doctor, to know how to handle it.

I have been dealing with nothing but PIP for 20 years now.  I am very experienced in the rules and correct procedures that are often changed by the Florida Legislature almost once a year.

If you have been in an accident, please call me first.  I will explain everything to you so you will be up to speed on the topic, and you don't make any mistakes which could cost you a lot of money down the road.

Dr. Alan Himmel, DC, PA.
954-659-8600

More Disruption Coming-- Autonomous Cars Will Change Auto Insurance Among Other Things...

More Disruption Coming-- Autonomous Cars Will Change Auto Insurance Among Other Things...

Dr. Alan Himmel-West Miramar Car Accident Injury Doctor

Autonomous cars are coming.  Get ready.  It is estimated that by 2025 there could be 600,000 autonomous cars on the road, and by 2035, there could be 21 million cars on the road. (1)

What is an autonomous car?  Well, it's a self driving car.  To paint the picture, this is probably what driving will be like in the future:  We will step into our cars with probably some futuristic doors which open up in  Lamborghini style in order for us to easily slide in with handfuls of carry-ons. Think of getting onto an airport shuttle bus.  We will step in, place our stuff on the side, and simply have a seat.  From there we will likely just speak our destination out loud, so that the navigation (GPS) hears us and figures out the best route.  A voice will come on and say, please buckle your seat belt, and inform us that we will be at our destination in 23 minutes and 16 seconds.  Ehh....no speeding anymore since we are not in control of the gas pedal.  And, at this point, the doors will shut, the system will make sure all passengers are safely secured, and we will be on our way.

Since we are no longer in control of our car, we could, if we want to just sit back and read the newspaper (if they still exist), do some computer work, watch a movie, or do anything else we want.
Even Sleep.

The trip will probably be very boring.  I figure it will be like being on a tour bus, with only one big difference; we have seen this city all before, since we live here.  This won't be like being on a tour bus travelling through Rome, unless you live in Rome.  There will be no reason to take your camera with you.

So, let's talk about how the autonomous car will change things, and there are plenty: The first thing that comes to mind, is that automated cars will reduce the amount of human error, since our cars will be controlled by computer software and hardware.  I know what you are thinking... GPS is very inaccurate and most of the time it sends you to the wrong place.  Believe me, this is a system which is in progress, and I would expect there to be gigantic improvements in GPS technology.  Eliminate human error and there are less injuries, and fatalities, because there are less accidents of all kinds. Car insurance companies will have to restructure the policies to account for the possibility of computer error, and those tech companies who created the system would be held liable for accidents.

And, I would expect cars with combustion engines (again, if they still exist) to be more efficient. Keeping you at a constant 45mph in a 45mph zone will save you gas.  It will also save your brakes.

How else would we expect life to change with autonomous cars?   Fewer car accidents mean fewer trips to a body shop.  Fewer car wrecks would mean fewer tow trucks on the road.  Calling a UBER driver (sorry Taxi Companies, it was good while it lasted but your days are numbered), will mean a driverless UBER car comes to you and picks you up.  There are billions of dollars going into making this happen.  Postal, UPS, and small package delivery will probably use these driverless vehicles also.

What if we don't want this?  Sorry, its coming.  Just about every car manufacturer is working on this to make it a reality, along with Apple, Google, Microsoft, just to name the obvious. (2) (3)
Let me put it to you this way:  When Google pays a billion dollars for a traffic app called Waze, do you think it is entirely for watching where the police are?  No.  Its all about the data that that app provides back to Google.  And, don't forget that just about everyone has a smart phone, which uses wifi and data, which is continuously sending information back to Apple and Google plotting your exact coordinates.  The information that these companies are gathering will one day be crucial to making these systems work.

For now, we are just starting to see a sprinkling of this new technology in our cars.  There have been self parking cars out for a few years now.  Also, blind spot monitoring in side view mirrors has been out for a while.  My 2014 Mazda has this feature.  I just saw a commercial on TV (can't remember the car company) showing a car that is available right now, that will completely avoid colliding into something.  They were demonstrating how the car automatically stops if a person walks out in front of a car which was driving straight ahead, and while the driver took his eyes off the road for a few seconds.  Pretty awesome, and that would prevent a rear end collision, too.

What if you are the type of person who likes to keep his car forever or you like the classic cars?  I doubt if these older cars would ever disappear completely, but you would expect them to be less and less common, just like we don't see many Model T's on the road very often.

In summary, we are living in some exciting times in terms of technology.  I am not sure if I am ready for it, because I still enjoy driving, and being in control of my car.  Our grandkids will likely look back and find it amusing that we actually use to drive our own cars.  

Miramar Chiropractor


References:
1. http://fortune.com/2016/06/07/autonomous-car-sales-ihs/
2. https://www.cbinsights.com/blog/autonomous-driverless-vehicles-corporations-list/
3. http://www.fastcompany.com/3024362/innovation-agents/10-autonomous-driving-companies-to-watch

Fat Belly? Your bigger concern should be Fatty Liver.

Fat Belly?  Your bigger concern should be Fatty Liver.

Alan Himmel, DC.

The next time you look in the mirror and look at your gut, you should be more concerned about what's happening on the inside, particularly to you liver.  The condition I am talking about is called Fatty Liver Disease, or Hepatic Steatosis.

What is normal?  

There is always a small amount of fat surrounding your liver.  A small amount (5-10%) of fat in the liver is considered normal.

Who is at risk?

If you drink alcohol (alcoholic liver disease), you are at risk, and this condition is clinically significant, because this may lead to cirrhosis, over time.

In pregnancy, fatty liver can be common.  If you are obese or even overweight, you are at risk.  These two causes are (NAFLD) or Non-alcoholic Fatty Liver Disease, and are clinically less significant and considered by some sources to be benign, although there is a causative link between fatty liver and type two diabetes, hepatitis, and advanced liver disease, such as cirrhosis as well.

What are the symptoms of fatty liver?

Generally, there are no symptoms.  It is one of those silent diseases.  If you carry a large amount of fat around your midsection, there is a good chance you have fatty liver.  In extreme cases, you may feel some fatigue, abdominal discomfort, enlargement of the liver, weakness, poor appetite, or weight loss.

What are the long term consequences?

In most cases of NAFLD, the long term clinical outcome is minimal with not much evidence of increased mortality.  However, there is a group of the population with with NAFLD that progresses to a more inflammatory liver disease called nonalcoholic steatohepatitis (NASH) which leads to hepatitis, end stage liver disease, and a lower chance of survival.

How is fatty liver diagnosed? 

Liver enzymes (transaminases) can be checked, but in many cases, the levels appear normal. Clinically, the signs of Fatty Liver would include high triglycerides, high cholesterol levels. Another way to check would be the use of  ultrasound.  Lastly, MRI or CAT scan can be used.

What can I do to prevent it fatty liver, and is it reversible?

 Fatty liver is one of those diseases which is preventable and often times reversible.  It is highly advised to stay away from a diet high in sugars, and in particular, high fructose corn syrup sweeteners which are found in many foods we eat, from soft drinks to tomato sauce.  Within the liver, these sugars undergo a process called lipogenesis, and much of that fat is stored in the liver and the viscera.  In order to reverse fatty liver, a diet devoid of high sugars and high fructose corn syrup, along with exercise, can lead to weight loss, and ultimately a reduction of fat in the liver.

Do you need some advice or counseling on effective ways to reduce or prevent fatty liver disease?  I have been in practice since 1996.  You can contact my office and make an appointment: 954-659-8600

Will Florida PIP Cover Me if I am Traveling out of Florida?

Will Florida PIP Cover Me if I am Traveling out of Florida?

Alan Himmel, DC PA

In your own car: YES.
In a car that is not yours, including a rental: NO
In Mexico:  NO
In Canada:  YES

Here is a scenario:  You are a Florida resident and have a Florida registered and insured car and travel north to go skiing in the Smoky Mountains.   You decide to pile your family into the family SUV, and make a trip. You manage to get through Florida and Georgia safely, but when you get into Tennessee, someone runs a red light and smashes into your car causing injuries. In this scenario, you were in your own car, so there IS coverage for you and your family.

Let's say you find that there is no snow in North Carolina and decide to travel into Canada?  Yes, there is PIP coverage for injuries to you and your family if you have an accident in Canada.

HOWEVER, lets say you decide to FLY to North Carolina, and rent a car.  You have an accident in North Carolina while occupying a rental car.  NO, there is no coverage under your Florida PIP policy. Same is true if you are in a friend's car in NC, It's not your car, so no PIP. 

Let's say you are in your relative's car in NC, providing that the relative is a NC resident, No Florida PIP here either.  How about if you are in a relative's car in NC and the relative is a Florida resident with car insurance coming from Florida?  No coverage here either unless you and the relative LIVE together.

In Mexico in your own car and there is NO coverage.

In regard to resident relatives:  There are some companies that will deny a claim if they determine that the policyholder did not disclose all people in the household when the policy was purchased.  They will deny the claim based on "material misrepresentation."    So, always let the company know all people living in the house, no matter if the addition of these extra people in the house will increase the cost of the policy.  If you hide this information from them, they will find out and may deny your claim.

I'm not a lawyer.  I am a chiropractor with 26 years experience treating auto accident patients, and I have been exposed to many different coverage scenarios.  Get all legal opinions from a licensed attorney.