Todd Winton, NMD
Jen Winton, DC

Auto accidents are prevalent in our fast-paced society. The US Census Bureau states that over 10.5 million motor vehicle accidents have occurred every year in the United States since 2000.¹ As a result, there are countless injured patients that need help and healing. What options does the injured patient have for treatment? Will the naturopathic profession stand up and embrace the ample opportunity that lies within? I (Dr Todd Winton) have been practicing naturopathic medicine for over 15 years, and with my wife/chiropractor, have together successfully navigated the Personal Injury (PI) arena. We are pleased to share this information so that more naturopathic colleagues will rise up and help these accident victims when traditional medicine cannot.

Typically, after a collision an ambulance and/or police will arrive on the scene. The police will present a citation to the driver at fault. All injured parties will be evaluated by EMTs if the accident is severe enough to warrant it. If the injured patient is found to have sustained serious injuries, they will be offered a ride in an ambulance to the closest hospital. Once there, they typically will have tests such as a CT scan, MRI, or X-rays of the injured regions. If no fracture, bleeding, or imminent pathologies are found on these studies, the patient will be released with pain medication, anti-inflammatories, or muscle relaxants (or a combination thereof). However, most people do not feel the worst of the symptoms for several days-to-weeks post-accident. At this point, they will need immediate care for their injuries so that they can get back to work or life activities. I often find they need much more than the medication they received at the hospital. This is where naturopathic doctors shine, with an expertise that no other doctor can offer for pain management.

Here is a list I have compiled of the simple steps to care for the injured automobile patient and to get paid handsomely by the insurance companies.

Define Who is At Fault

There are 3 basic scenarios for determining who is at fault, the answer to which will determine who will pay your claims.

Your Patient is At Fault

If your patient is determined to be at fault, you can find out if they have MedPay coverage or Personal Injury Protection (PIP) on their own automobile insurance policy. The patient may have 1 but not both. If the patient does not have either type of insurance, you would treat them as a self-pay patient rather than a personal injury case.

If they do have MedPay or PIP, how do you determine the difference between the 2?

MedPay coverage usually covers your patient’s medical, surgical, dental, chiropractic, and naturopathic treatments, as well as ambulance, hospital, X-rays, and other studies that are considered medically necessary and reasonable
PIP coverage includes everything that MedPay does; however, additional expenses, such as physical therapy, psychiatric expenses, and lost wages from work, can also be covered
In some states, such as Oregon, PIP coverage is mandatory. In other states, patients must specifically ask for the coverage to be added. We often find that the patient may have coverage and not even know it, so it pays to ask the patient’s insurance company in advance.

Your Patient is Not At Fault

If your patient is not at fault, then the other driver(s) (at fault) will have insurance that should cover the “bodily injury.” This is called Third Party Insurance. In this case, make sure that your patient has an open claim with the Third Party Insurance and that they give you this information on the first day of treatment, including claim number, the name of the Third Party Insurance, phone number, and the insurance adjuster’s name.

In Arizona, it is crucial that you file a lien on the case with your County Recorder’s office. If not, the patient will likely get your check at the end of the case, and it is up to the patient to pay your bill. We don’t suggest skipping this step. For all Third Party Insurance billing with a lien, you will submit all claims after your treatment is done. Take note that collections can take up to 2 years after the patient has completed treatment, and some patients continue to be treated for a very long time. This is a waiting game, but well worth it in the long run. Most of the time, payment is received within 6 months to 1 year.

Your Patient is Not At Fault, and Has MedPay or PIP Insurance

In this case, follow all of the steps above, with the lien; however, in this case, you will be billing the PIP or MedPay insurance first. This is the best scenario, since the MedPay or PIP will pay immediately (you can bill as you treat) and then settle the difference with the Third Party Insurance company at the end of the care plan.

Warning: many insurance companies will call your patient and record the phone call. The insurance companies are eager to minimize costs and close the case as quickly as possible. It is typical for them to call your patient within a week of their accident and get them to “settle” for a few-hundred dollars. There have been recent cases in Arizona where the patient said they were fine but still got treated for symptoms. Since the insurance company recorded the call, all of the medical bills were dismissed, even though the patient was not fine. Be sure to educate your patients about this tactic so that they get the care they genuinely need.

Consultation, Exam & Treatment

On your first visit with the injured patient, make sure to do a thorough consultation and exam, being meticulous with your notes. Always take your notes with the thought in mind that these notes may be subpoenaed and that you may have to stand up in court to justify your documentation.

Note, on examination, any areas of palpatory tenderness, edema, or other signs of inflammation. If there is any bruising or lacerations, it’s wise to take photos of the area (think: protecting your patient in the courtroom). Perform any necessary orthopedic tests, including active and passive range of motion of the affected joints, and note any trigger points found on exam. It’s crucial to document these trigger points in detail, to provide medical necessity if you are going to provide trigger-point injections.

Naturopathic doctors can provide several treatments to the injured patient. In our clinic, we offer muscle relaxers and/or anti-inflammatories if warranted, and trigger-point injections. Some naturopathic doctors choose to treat with acupuncture as well. All of these are typically covered, since they are considered standard of care.

Of course, you will need to diagnose your patient properly using the relevant ICD-10 codes. If you need assistance with choosing the correct codes, make sure you update your knowledge base with a coding seminar, or purchase a current ICD-10 coding book. The following table represents the CPT codes we utilize in our clinic and which have been successfully paid by insurance companies. For fees, please check the reasonable fees for your area.

Table 1. Useful CPT Codes in Injury Cases

CPT Code	Description
99202-99204	Consultation and examination
99212-99214	Reevaluation or office visits
20552	Trigger points, 1-2 muscles
20553	Trigger points, 3 or more muscles
97014	Electric muscle stimulation
97110	Exercise program, 8 minutes or more
97012	Traction
97140	Manual therapy

We typically find that it takes 6-20 weeks for a patient to reach maximum medical improvement, depending on the severity of injuries.

For cases that are more complicated, it may be wise to have your patient contact an attorney. A good PI attorney is also helpful for your patient when they have lost wages due to time off work. When an attorney is assigned to a case, all Third Party billing will be forwarded to the attorney, not the insurance company. The good news is that you can still bill the MedPay or PIP first when utilizing an attorney. Networking with reputable attorneys in your area is a great idea. They may send you patients as well, for a win-win relationship. Find one that does not ask you to cut your case fees or minimize the reduction.

One local attorney with whom we work recently recommended the importance of co-treating with at least 1 other doctor. This gives the case more validity in case of litigation with the insurance companies. We discuss this further in the next topic.

Co-Treating with Other Doctors

In our clinic, we have combined naturopathic care, chiropractic treatments, and therapeutic massage. This multi-disciplinary model has been highly successful for the patient’s speed of recovery and healing. Again, because this model incorporates 2 different doctors’ evaluations, the insurance companies have a more difficult time disputing payment of the claims.

Typically, we schedule the patient with the chiropractor first. A thorough consultation and physical exam is performed, along with interferential treatment, possible chiropractic manipulation, and gentle home-exercises. The patient is typically referred out for X-rays to rule out fracture or pathology, unless they have already been taken prior to the visit. On the second visit, the chiropractor will review X-rays, recommend a treatment plan, and provide additional manipulation and/or interferential therapy. The patient will also have their first naturopathic evaluation on this second visit. If warranted, I will offer anti-inflammatories and/or muscle relaxers, provide trigger-point injections, and recommend a treatment plan in conjunction with the chiropractor. We find that when the chiropractor recommends 3 times per week, trigger-point injections are given at a frequency of 2 times per week. When chiropractic care reduces to 2 times per week, injections decrease to 1 time per week. The multi-disciplinary approach is extremely effective in ameliorating the accident-related injuries. Not to mention, the patients’ expectations of care are almost always exceeded, since they have 2 doctors working synergistically together for their benefit.

I suggest any naturopathic doctor wanting to treat the automobile-injured patient should strongly consider teaming up with a local chiropractor who is knowledgeable in PI work. Whether you work in the same clinic or nearby is irrelevant, as long as both doctors maintain clear communication regarding the patient’s progress.

With the abundance of accidents occurring every day on the roads, injured patients can find the care they desperately need with more naturopathic physicians available to answer the call. There are a multitude of PI seminars available, to gain some additional insight on this process.

Todd Winton, NMD, specializes in natural pain management and hormone therapies at the Active Lifestyle Clinic in Phoenix, Arizona.Dr Winton works with his wife Jen Winton, DC, creating a unique multidisciplinary practice.Dr Todd Winton received his naturopathic degree from Southwest College of Naturopathic Medicine in 1999. Dr Jen Winton received her chiropractic degree from Palmer College of Chiropractic West in 2003.

References

S. Census Bureau. Statistical Abstract of the United States: 2012. Transportation, Section 23; pg 693. Available at: https://www.census.gov/prod/2011pubs/12statab/trans.pdf. Accessed February 15, 2016.
Abraham M. Current Procedural Terminology 2011. Chicago, IL: American Medical Association; 2010