Aviation vs. Pinnacol

(David vs. Goliath)

Attention Pinnacol Policyholders!

 

You may have recently received a letter from Pinnacol Assurance indicating that we are not a member of their “SelectNet Network”.  We haven’t been since November of 2015, so this is nothing new.  That letter encourages you to migrate over to another provider that is part of SelectNet, and indicates that if you don’t, they will do it for you!  We want you to know that we value your business and the relationships that we have with our clients.  You should know that we are not required to participate in their network to see your injured workers.  Also, there is nothing that requires you to designate providers solely from within their network.  And finally, know that they have no authority to change your clinic designations without your direction or consent.  Their letter declares that they intend to anyway, which is why we are contacting you.

 

Since 2015 we have continuously provided care for Pinnacol insureds and their injured workers without network participation, as allowed by Colorado law.  For all workers compensation patients, we use the Colorado workers compensation fee schedule to determine what we bill Pinnacol (and other insurance companies) for our services. This fee schedule is exhaustive and is set up specifically to control what providers can charge.  We still maintain an active Pinnacol Provider number (#113840) that you can continue to use to designate us in their system. 

 

The letter Pinnacol sent out encourages you to remove us from your designated provider list, and states that, unless you re-affirm your designation of us before 10/16/2022, Pinnacol WILL REPLACE US WITH A CLINIC OF THEIR CHOOSING.  We believe this to be an inappropriate attempt to dictate which provider you should use, based strictly on our decision not to participate in their SelectNet network. We also believe that a workers compensation insurance company should not change YOUR provider list without your direction.  They may obviously “recommend” their SelectNet Network, but one look at that list and you will see that many are large corporate providers that may not provide you with the same level of attention that you and your employees receive from Aviation & Occupational Medicine. We are here for you first, and foremost.

 

Additionally, we want to point out that, contrary to Pinnacol’s assertions, we don’t believe that there is a direct correlation between lower claims costs or premiums, simply “because a SelectNet provider is required to offer a discount”. 

 

Overall lower claims costs come from responsible care with a focus on return to work, not “discounts” off each visit.  If we’re able to complete care in half the visits and without sending “everyone” to PT like the competition seems to do, the nominal network discount (10% or less per visit) provides no savings for the policyholder at all. It is obvious that the provider offering “the discount” will still cost more overall, and that is what is considered when an underwriter looks at the experience modification for setting rates.  Overall Claim Cost is the driving factor for premium increases.  As a small, independent clinic without massive corporate oversight, we get to know each customer and each patient intimately and provide the correct care, at the right time, to get your injured employee back to work and enjoying their activities of daily life.

 

If you previously designated us, there “should” be no requirement for you to “re-affirm your designation” as they state you must do.  That said, and to ensure that they DON’T remove us from your provider list without approval, please see the attached “Reaffirmation of Designation” form which we’re asking you to fill out and FAX to Pinnacol.  For those of you that are bothered by Pinnacol’s letter and attempt to dictate who you use for care, we request that you also CALL Pinnacol at 303-361-4000 AND 303-361-4892 to let them know that you are happy with your current provider and that you DO NOT wish to have us removed.

 

As the employer you have the right to choose any competent licensed physicians or clinics to care for your injured workers, regardless of who’s network they are or aren’t in, or if they’re on the list that Pinnacol keeps for you on their website.  That list is provided under the guise of “ensuring compliance”, but more effectively it is used and viewed as an object of “implied rule” to control who you think you can and can’t use – which is 100% False.  The only compliance action required under House Bill 14-1383 is Timely Presentation of a “four designated providers list” to the injured worker at the time of injury.  Nothing less, nothing more.

 

We have spent years developing personal relationships with our clients which allows us to provide the type of service that you want and deserve, at a reasonable cost to Pinnacol.  We do not follow the “corporate protocols” of some national clinics in treatment of the injured worker and for you that is a good thing. However, now we really need YOUR help. Like many of you we are still climbing out of the 2 Year hole that was COVID and are getting back on track financially.  If Pinnacol is successful in driving enough business away from our clinic, as they intend to do, it may bring an end to our 30+ years of medicine.

 

We are obviously pursuing all legal means available to us to put a stop to this, but in the meantime, we ask for your support by continuing to do business with us. 

 

If you have any questions or wish to discuss this or any other matter concerning your account, please contact TONY BAKER, C.O.O. at 720-647-3674 directly.