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Trust is the number one factor in any relationship. Most of the medical providers I have worked with have stories of being mistreated by lawyers. They complain of lawyers that lied about settlements, did not honor their letters of protection, asked for outrageous reductions, etc. Sometimes the provider has been burned enough that they refuse to work personal injury cases ever again. I get angry with the lawyers that have done these things, they hurt our profession.

I have been very fortunate to have several very close, trusting relationships with my providers. They often become so trusting that they stop wanting the usual paper trail of documentation, but I provide it anyway. I do things by the book all the time.

If you are a medical provider that has patients injured by third parties, your patients will likely want an attorney. You could leave the entire legal aspect of the patient’s injury up to the patient. I would suggest that doing so is bad for the patient and you. If the patient seeks a lawyer without guidance, there is a strong chance they could end up with one of the lawyers you don’t want to deal with. The average person does not know any lawyers. If they need one, they can only find out about lawyers through radio ads, television and friends. Let’s face it, people are busy. When a busy person is injured the last thing on their mind is how to shop for the “right” attorney. A better practice is to have a list of attorneys you have worked with and trust. To protect yourself, you should be sure to place a disclaimer on the list stating you are not making any statements as to the qualifications of any one lawyer over another, that the list is simply provided as a courtesy to patients. This way you increase the odds of having attorneys involved that you like, as opposed to those you don’t know or don’t like.

In dealing with attorneys, don’t ever pre-agree to a reduction or make a sweeping statement of how much you would be willing to reduce in general. Such statements set you up for a host of problems. If you pre-agree to reductions then your charged bill is overinflated from the start. Reductions, when necessary are a case by case analysis determined by the total billing and the final offer or jury award. Don’t feel bad about asking the lawyer to give you details about requested reductions. You should be able to find out what the total offer was, if there was PIP or other insurance, what the total bills were, who has reduced and such. The lawyer cannot tell you what the client is getting due to confidentiality, but if you have every number except the patient/client’s number it is easy to figure out what is happening. The important thing about reduction requests is that they be fair. Every person in the case has a vested interest in the outcome. The attorney has worked to settle it, the doctors provided valuable services, the health insurance company’s have contractual rights, and the patient/client suffered an injury. No person should be asked to suffer a disproportionate share.

There are firms out there who ask for a 50% reduction of almost every case, no matter what. I personally find this kind of request insulting. The firms that get away with it do so because they have the largest market share of clients. They can essentially force a provider to accept a huge reduction because they have the threat of not sending cases to that provider ever again. This is not a friendly business relationship of mutual trust. These firms have made the decision that business is business, and honesty, integrity and friendship have nothing to do with business.

I prefer to enjoy my relationships with the providers I work with. I enjoy having lunch with them occasionally, in letting them know the status of cases, and in getting them as much value on a case as possible, just as I try to get the best value for my client. I wish I could say I never had to seek a reduction, but it happens. When it does, I present the provider with every total except the client’s take-home. I ask only for the reduction I need to meet the client’s desired outcome and still pay all the other bills, expenses and fees. I never ask for a reduction unless I have already reduced my expected fee.

If you are a medical provider looking to establish new relationships with an honest hard working lawyer, give me a call. I’d love to come see your office, maybe have lunch, and see if we have a match of ethics, desire and drive to provide service to our mutual customer.

When a client is represented by a lawyer, the lawyer can issue a letter to the doctor asking the doctor to hold the bill for collection, and promising to pay the doctor out of the proceeds of the case. This letter is usually called a Letter of Protection (LOP). The LOP does not make the lawyer responsible for the bill. The bill remains a contract between the patient/client and the doctor. The LOP does become a contract between the lawyer and the doctor.

Some are critical of the LOP. The most critical are insurance companies. Insurance companies don’t like LOP’s because they allow a person without cash or health insurance to generate medical bills that must be compensated. Insurance companies also like to make an LOP sound like some sort of sinister collusion between the doctor and the lawyer. They argue like to imply that the bills are higher than they would normally be because of the LOP and some plan to drive he costs up in hopes of a bigger settlement.

In reality the LOP is the only way some people can get the care they need as a result of somebody else’s negligent conduct. If you don’t have health insurance, or can’t afford your co-pays, then you can’t get medical care at a price that fits your budget. Inmost cases the LOP is just like a credit extension. The bill is whatever it would have been, the payment is just deferred. There is no reason to drive the bill up beyond normal because the case value is a function of reasonable and necessary care, as with any case. If the bills are artificially high, the settlement will not cover the bills. Since the doctor knows the LOP does not make the lawyer responsible, having an unpaid bill with a client who cannot afford to pay makes no sense.

Thee is some debate as to which is better to use, an LOP, health insurance, or a combination of both. If your health insurance is used, the defendant’s insurer gets the advantage of tort reform legislation which says (in a hotly debated issue) the dollar damage should be what the insurer paid, not the full bill charged. This comes from the Paid versus Incurred argument in Texas. Usually health insurance pays a discounted rate, on average 20% off the bill. The legislation says that discounted rate is the bill, not the full charge. Some therefore argue that health insurance should be avoided, so that the full bill is reimbursable. There is a problem with that logic too though. If things go wrong in the case, the client is responsible for the full bill. It may not be possible to seek health coverage after the fact. Advising a client not to use health could backfire; making the client responsible for a bill that health insurance would have paid.

I usually inform my clients of the issue and let them and the doctor decide what they want to do. For me the LOP is chiefly a tool to use when there is no health insurance.