Colorado’s switch from no-fault automobile insurance to a tort system last summer has some holistic health care practitioners running for the hills – or out of the hills. Some chiropractors have left Colorado, and some acupuncturists, personal trainers and massage therapists are surviving on cash-only customers.
Under the former no-fault system’s personal injury protection, auto-accident victims were guaranteed $100,000 in medical and rehabilitative coverage. Under the tort system, drivers are required to carry a minimum of $25,000 per person and $50,000 per accident in bodily liability coverage and a minimum of $15,000 in property damage liability. The tort system requires liability coverage but drivers are vulnerable if they are at fault and not covered by Med-Pay or a health insurance plan, and the at-fault driver also is at risk for a lawsuit.
The change has led some holistic health care practitioners to refuse insurance payments, resulting in a loss of patients who cannot afford to pay out of pocket. Practitioners who do accept insurance plans say they are losing time and money, and often have to wait months or years for settlement payments. And all of the holistic practitioners are losing referrals from primary doctors because, under the tort system’s minimum liability coverage, there is not enough money to go around.
Sue Buell owns Monument-based Massage for Health, and, with a solid base of private-pay clients, her business has not been negatively impacted. Buell said one of the biggest drawbacks to the tort system is the long reimbursements waits. “It is hard to get paid in a timely manner,” Buell said, “because insurance companies will not pay until everything is settled.” Buell said people who decline Med-Pay coverage have no recourse under the tort system but to pay privately for her services.
Cathy DiMaggio, owner of Black Forest Acupuncture, said she also has ample private-pay clients to maintain a thriving practice. However, accident victims who only have minimal auto coverage might be saving money on insurance costs but could be compromising their care, she said. “If auto insurance or health care insurance won’t pay for our services, many won’t get it because they can’t afford it,” DiMaggio said. “Eventually they end up not being able to work because they didn’t get proper care at the time of the accident.”
Falcon-based chiropractor Dr. Scott Miller said that when he worked under a tort system in Atlanta, Ga., most auto accidents ended up being litigated. “In order to treat the patients, they would have to sign a lien stating they are responsible for paying regardless of the court outcome,” he said. “It could take three years before the case was settled, and the provider oftentimes had to agree to a lesser amount than the normal charges. Many times the court wrote the settlement checks to the patients, and we’d have to track them down in order to be paid. Unless a patient had Med-Pay coverage, we wouldn’t see payment for months or years.”
Miller celebrated his first year in business in Colorado in February. He said that although the tort system skewed his business plan, it has not directly affected him. However, Miller said he knows “at least four chiropractors who left the state because of the tort system.” He said health plan policies do not necessarily cover auto accidents or chiropractors. The bottom line, Miller said, is that people will have to sue if they want quality care following an auto-related injury.
Dr. Michael Nehring is a Denver chiropractor and the medical director for Capstone Chiropractic Network LLC. He also is not a fan of the tort system. “Doing away with the no-fault system is a tragic course of events, and it forces litigation,” Nehring said.
Capstone is comprised of 340 statewide chiropractic providers who are identified for inclusion based on ethics and best practices, including standardized documentation, evaluation and treatment goals.
Limiting abusive practices and reducing costs were two reasons that legislators cited when voting for the tort system, Nehring said. However, Colorado drivers who want to maintain adequate accident protection need to add Med-Pay coverage, so the cost savings, he said, are minimal. Nehring added a $25,000 Med-Pay policy to his minimum liability coverage, and his savings, compared to the cost under the no-fault system, totaled $12. Nehring’s insurance company also dropped his teenage daughter from the basic liability coverage.
“Most people are not saving money,” Nehring said. “The costs have simply shifted from auto coverage to health plans or cash payments. There is a risk to appropriate care outcomes, which will create a plethora of ill effects. When consumers are personally responsible for their own health care, they utilize it less. If people are not treated properly for auto-related injuries, they may turn to over-the-counter drugs or even alcohol to alleviate the pain and stress.”
Nehring said legislators and interested parties tried to reform the no-fault system before applying the tort system but nothing was acceptable. Instead of going back to the table, “we just went from one extreme to another,” Nehring said. There are other solutions, Nehring said, to the abuses that occur when practitioners run up the charges through ineffective treatment plans.
Nehring said legislators traded bad ethics for bad ethics when they traded the no-fault system for the tort system. “If the liability coverage is only $5,000 for a passenger, a doctor is not inclined to refer out for necessary tests because there isn’t enough money to go around,” he said. “It’s a pathetic reality in health care.”
Another reality, Nehring said, is the doctor/lawyer team that preys on accident victims. Nehring said that while some chiropractors have left the state, accident-chasing lawyers and doctors have moved in. “It’s called claim building,” Nehring said. “The doctors manipulate the diagnosis to set up the lawsuit, and it stinks to high heaven.”
Nehring said that if the state’s chiropractors do not take on these issues and problems, they will be legislated out of third-party reimbursements.
Most states have a manageable tort system, Nehring said. Colorado needs to look at how those systems are working and reform the current system, he said.
But Nehring believes it will take a tragic accident involving a high-profile family and a serious injury or death for lawmakers to rethink the tort system. Only then, Nehring said, will we come back to talk about reform that offers some “middle ground.”