Proposed ICBC Changes Defy Patient Rights — Dr. Brian Arthur, Chairman, ICBC Liasion Committee
The ICBC Liaison Committee/BCAA urgently needs your help. ICBC is preparing a proposal to the government to change Part 7 Benefits and limit chiropractic care. ICBC has not consulted the BCCA in this matter and is acing unilaterally. We have asked ICBC for a draft coy of its proposed changes. However, they have stated that the legislative counsel has not finalized the wording and until then, will not provide the BCCA with copy. In addition, they will not specify the intent of the changes.
Under the existing wording of Part 7 Benefits, there are several legal remedies that can preserve our patients' rights to benefits and who determines necessary chiropractic care. The BCCA immediately needs appropriate claimants to initiate these legal remedies.
Included with your Contact Newsletter are:
1. A series of sample form letters to be retyped on practitioner's company letterhead
2. A list of patient criteria to help select an appropriate patient for litigation
3. A letter from an ICBC Claims Centre Manager, Mr. Gerry Tyller
The form letters should be sent to an adjuster each time the adjuster refuses to pay for chiropractic benefits, a claim submission is rejected by a VX code, or ICBC attempts to divert the patient to other care. The letters are self-explanatory and cover key issues with ICBC. Some of the enclosed sample letters are for patients. The letters are simple and concise, yet contain the necessary legal wording regarding patient entitlement to Part 7 Benefits and necessary chiropractic care. It is the committee's sincere hope that doctors will help patients with these letters if necessary. If a doctor has a patient that is a suitable candidate for litigation, please contact the Association office. It is crucial that you fax or send a copy of each original letter to the Association office (Fax 604-278-0093)
ICBC Claims Centre Manager Gerry Tyller states in his letter that he has "instructed them (adjusters) that Chiropractic treatments do not require a General Practitioner's referral before treatment can be initiated or paid for under Part 7 Benefits." The committee asks that each doctor keep this letter on file. It may be useful at a later date when dealing with VX codes and the issue of necessary chiropractic care. However, at present, we need practitioners to send the above form letters to adjuster until further notice.
ICBC recently sent copies of pages 2, 3 and 4 of the Claims Procedure Manual to all claims staff. These sections deal with patient visit charges, surcharging (their term) and direct billing to ICBC. If you charge above the MSP rates, remember to advise each ICBC patient that they are responsible for the difference between your office visits and/or X-ray fee and the amount ICBC will pay. Until now, many adjusters have been reimbursing patients for the difference, although technically, they do not have to. If patients submit expenses to adjusters, the expenses should be termed office visit fees. Terminology that gives the appearance that ICBC is responsible for out-of-pocket expenses is appropriate. Remember that if the patient has extended benefits through another insurer, ICBC mandates that the claimant submit their out-of-pocket expenses to their extended health carrier. If the patient has a tort claim, but no extended health coverage, or their carrier will not reimburse them, they can be reimbursed under "special damages" when settling their claim.
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