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How is Ordering a Wheelchair the “Cost of Doing Business”?

The new wave in insurance denials (from assessors and adjusters) is that planning and communication time is “the cost of doing business”.  Huh?  Until you spend a day with me, at my desk, in my car, on my phone, and in my client visits, how do you know my “business”?  I can tell you that it goes like this:  for every hour I spend with a client, I spend an equal hour doing the follow-up that came from the visit in the first place.  And for CAT files, make that two hours.  What am I doing in that time?  I am calling vendors to source equipment, trying to get the best price, best client service, and the most appropriate devices.  I am researching practical and inexpensive solutions on the internet.  I am calling other team members to discuss functional issues, and to ensure collaborative but not duplicated service.  I am arranging attendant care as if they need attendant care, they often need someone to coordinate it.  I am trying to obtain funding approval from the insurer, or trying to save the client’s rehabilitation dollars by hooking them up with public services.  I am receiving calls from my client to tell me the cast came off, that the new medication is helping, and that they are trying to use the cognitive strategies we discussed.  I am reminding them of the things I am waiting on, or sourcing for them, or the calls that have not been returned. 

Sound like case management?  It is not, it is OT and those services are necessary for the provision of our therapy.  And believe me, calling to get quotes on devices is a lot cheaper than driving to the client each time to meet with a different vendor.  “Planning and communication time” actually saves money.

But what is concerning, and also comical, is that the people who are telling us what “is the cost of doing business” are getting paid the entire time.  The adjuster that denies planning time and spends 30 minutes on the phone arguing with us is getting paid.  We are not.  Or, the examination OT that got paid to review our plan and cut us off from a few treatment hours.  When was the last time that OT actually treated a client anyway?

I have had two epic conversations with adjusters that drive this point home.  In one case, the adjuster and I got off topic and started chatting about housing.  After 30 minutes he said “are you charging me for this phone call”?  I responded with “first of all, I don’t charge you, I charge my client, and no, I am not going to charge my client because you kept me on the phone for 30 minutes”.  I then said, “but you are getting paid to talk to me, right?”  He said “well I make less than you”.  My response was “not in the last 30 minutes”.  He laughed.  The other conversation was even more interesting.  An adjuster was going to arrange for an assessment to question our kilometer costs (which had been approved on the file for the last three years but she was covering the desk due to a vacation).  Again I spent 30 minutes on the phone explaining that this has never been challenged.  I did the math and she was disputing $4.80.  I asked her if she was seriously going to arrange for a $1500 assessment to question $4.80?  Apparently she was.  So I said “don’t worry about it then, I will eat the $4.80”.  I wonder if her employer knew that they paid her probably an hour of salary to save them $4.80.  Ridiculous.

 But the biggest thing insurers and assessors need to remember is that the CLIENT has approved that time and those costs.  We are required to review our plans with those we are treating, and to get their signature and authorization.  We explain to people that often we spend significant time behind the scenes getting the job done.  They understand this and approve those expenses as “necessary” for their treatment.  Then, we demonstrate this to be the case as we remain in contact with them and are very proactive at helping them to function better – directly and indirectly.  Honestly, the nickel and diming is ultimately costing the industry more, and reducing the quality of care received by injured people.
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