Doctors who treat on a lien in California need to know about the Pebley case. Sometimes, a patient will seek out the best doctor to treat their injuries from car accidents, and the doctor does not take their insurance. In this case, you're essentially uninsured, and you must treat your injuries on a lien if you can't afford to pay the doctor out of pocket.
The Pebley v. Santa Clara Organics, LLC case is an important ruling that can have significant implications for healthcare providers like chiropractors who treat personal injury patients on a lien basis.
The case essentially affirmed that an injured plaintiff who chooses to treat with doctors on a lien basis—as opposed to using their health insurance—should be considered "uninsured" for the purposes of determining recoverable medical expenses. In practice, this means that the "reasonable value" of the medical services could be based on the provider's regular rates, not the discounted rates negotiated by insurance companies.
Here are some key takeaways that might be relevant to your practice:
- Higher Rates: The decision allows healthcare providers treating on a lien basis to potentially charge higher, customary rates rather than discounted insurance rates.
- Expert Testimony: The decision also discusses the use of expert testimony to prove up the "reasonable value" of medical services. This could be relevant if you ever find yourself needing to justify your rates in a legal context.
- Choice of Care: It underscores the plaintiff's right to choose their medical care. If a plaintiff decides not to use their insurance and opts for treatment on a lien basis, their choice should not limit their ability to recover the full "reasonable value" of those services.
- Potential for Larger Settlements: With the possibility of claiming higher medical expenses as damages, plaintiffs might secure larger settlements or awards, which in turn could mean a larger amount available to satisfy medical liens.
- Ethical Considerations: While the case provides the possibility of charging higher rates, healthcare providers should still consider the ethical implications and how it affects the patient's portion of a settlement.
- Contractual Obligations: The ruling doesn't negate any contractual obligations you might have with insurance providers, so you should be cautious in how you apply this decision to your billing practices.
Understanding the Pebley case could provide you with more leverage in lien negotiations and could affect your decisions on whether to treat patients on a lien basis versus through their insurance. Given that you specialize in treating neck pain after whiplash accidents often related to personal injuries, this case law could be particularly relevant for your practice.