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Collateral Sources in life care plans

  • 1.  Collateral Sources in life care plans

    Posted 08-07-2015 14:13

    More and more, I am facing arguments that I should be using collateral sources to fund various things in my life care plans.  Can I hear from anyone who has a sound argument against this?  I know what I have been taught.  It just seems to be growing by leaps and bounds.  Many thanks.


    ------------------------------
    Bob Gisclair
    Rehab Counselor, Certified Life Care Planner
    boba@gisclair.com
    Baton Rouge, LA United States
    ------------------------------



  • 2.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 14:26

    It really has nothing to do with what is "Taught" to life Care Planners.  It is a legal argument and depends on the jurisdiction.  You should include whatever is required by the relevant court.  Your or the attorney can argue about the uncertainty factor, but the inclusion of collateral sources is a legal decision and not a clinical rehabilitation or nursing decision.

     






  • 3.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 14:33

    That does make me feel better, as Louisiana is a collateral source state.  The argument is that one should accept less than usual and customary, since the doctors will discount insurance company payments.  Why not discount life  care plans?  That doesn't quite make sense to me.  Does it to you?

     

    Bob

     






  • 4.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 14:57

    It is not a matter of discounting or deciding what the plaintiff gets.  The Life Care Plan represents the needs and the associated costs.  It is just as true to show retail charges and also  to show what the current collateral sources are likely to pay.  We don't decide how the issue is resolved.  We only provide the information for the judge and / or jury.   By doing a thorough investigation of the collateral source plans you, may find, for example, that lifetime therapy is limited or other issues that will show a truer picture of likely total out of pocket cost to the plaintiff.  In any case, we don't decide – we only present the available information in a format that allows everyone to understand.  The inclusion of collateral sources is not a moral issue.  It is a legal argument for the lawyers and judges to resolve.

     






  • 5.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 14:58

    Thanks Mona…………..

     






  • 6.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 14:38

    In my experience, and along the lines of what Mona just said, it's jurisdictional.  In TN, the legislation is trying to pass the collateral source rule whereby collateral sources are required to be considered in settlements.  This is still on the table, but that's been my experience in most states.

    I hope this helps.

    Mary


    Mary Salerno RN, MSN, CRRN, CDMS, LNCC, CCM, CBIS, CLCP
    Certified Life Care Planner
    Catastrophic Case Manager

    M. Salerno & Associates, Inc.
    A Medical Legal Nurse Consulting Corporation
    Maryville, TN USA
    mary.salerno@msalernoinc.com
    ------------------------------




  • 7.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 14:57

    Thanks Mary………….

     






  • 8.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 14:57
    Collateral sources may be considered in the context of med mal.





  • 9.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 15:03

    Again, I believe that is jurisdictional even in med mal.

    Bob....I totally disagree with the collateral resource issue.  For example, if a person has BC/BS at this current time and we use the BCBS reimbursement rates for the LCP, what happens if and when they no longer have BCBS and they are paying cash?  Or if it a work comp case (which I have had) and comp's "preferred vendors" no longer offer the current discounts.....again, the costs are higher than what has been allowed. 

    Some states have asked me to use fee schedule costs for my LCPs and I ask them to please apply their fee schedule discounts to my LCP retail costs. I explain to them that if a person is hurt in one state and moves to another state, providers may not charge the discounted fee schedule rates.  It's a slippery slope from the ethics perspective, IMHO.

    Mary



    ------------------------------
    Mary Salerno RN, MSN, CRRN, CDMS, LNCC, CCM, CBIS, CLCP
    Certified Life Care Planner
    Catastrophic Case Manager

    M. Salerno & Associates, Inc.
    A Medical Legal Nurse Consulting Corporation
    Maryville, TN USA
    mary.salerno@msalernoinc.com
    ------------------------------




  • 10.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 15:06

    Thanks Mary!

     






  • 11.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 15:09
    I totally agree, Mary





  • 12.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 15:32
    Just wait for the obamacare questions start !!!

    Sent from my iPhone





  • 13.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 17:21
    Every state (sticking to the U.S. now and not Canada) will have a collateral source rule that is determined by either statute or case law.    There are also federal court rules if your case is venued in federal court.  You need to make sure you have an awareness of what applies to your case.

    In my experience, and I have handled cases from HI to ME with many points in between, a good rule is that if the case is NOT a case involving a claim of medical negligence, collateral sources cannot be used to pay for future medical care needs. If the case involves a claim of medical negligence, then depending on the venue, collateral sources could be used.  PLEASE ASK THIS QUESTION OF YOUR RETAINING ATTORNEY AND GET THE ANSWER AS IT APPLIES TO YOUR CASE!  THE ANSWER IS CRITICAL!

    So, what does this mean? It means that payment for items from such entities as state agencies can be considered.  A big however, though, is whether that entity has rights of subrogation and expects to recover from the jury verdict or settlement what they have paid out .  WC carriers, by statute, usually have the first bite at the settlement.   This does not mean however, that you can use a WC fee schedule as a collateral source. The reason for this is simple. Once the third-party case is done and the carrier is paid back, all future care needs must be paid for by the plaintiff. This issue can get more complicated, but that is the general rule.

    The other issue that is always a consideration is whether a charge is reasonable and customary/usual and customary or discounted.  Is the charge based on a fee schedule, insurance reimbursement, billed charge, the discount, etc?   All of these questions must be considered whether not collateral sources might apply.

    Let whatever standards of practice and codes of ethics that apply to you also guide your practice.   

    Bob

    Robert H. Taylor
    4745 Tanglewood Trail
    Boulder, CO 80301-3928
    (928) 713-6833









  • 14.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 17:51

    While I agree with most of the comments regarding the "old" collateral source rule, it is my understanding that now we will have to contend with the ObamaCare (Affordable Health Care) intrusions.  I am awaiting more discussion this issue at the up coming LCP conference in Scottsdale Sept 19-20 as I see this topic is on the agenda.

    ------------------------------
    G. Michael Graham
    Consultant, President
    gmgedd@yahoo.com
    Kapolei, HI United States
    ------------------------------




  • 15.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 18:17

    Same here Michael.  Thanks.

     

    Bob

     






  • 16.  RE: Collateral Sources in life care plans

    Posted 08-07-2015 18:22

    Very informative.  Thanks Bob!

     






  • 17.  RE: Collateral Sources in life care plans

    Posted 08-08-2015 01:33


    So how does one prove that an evaluee  will receive a discount that is found by the LCPer?  How does a LCPer guarantee that the present State political government will allow for services.  As an example isn't places like Texas, Louisiana, North Carolina trying to prevent women''s health care because it's against their political or religious thinking?  Why would a LCPer want to be part of a political or religious debate?


    Ronald Smolarski
    Director
    ron@beaconrehab.com
    Ann Arbor, MI United States
    ------------------------------




  • 18.  RE: Collateral Sources in life care plans

    Posted 08-08-2015 05:50

    I agree with Ron. We evaluate needs. We evaluate the market value of those needs. As life care planners, we must resist becoming part of a political agenda, even though we are under tremendous pressure to surrender to the dark side, disguised coyly as  efficiency.

    All market prices of goods and services, by definition, rest on the best perceptions of buyers and sellers, of the risks associated with the research, development, production and distribution of the item in question. This is why market prices represent an equilibrium between the forces of risk and the forces of demand to produce that product or service.

    Bond price and yields in the market are a perfect example of this equilibrium. No one will argue that price of a bond will not decrease in the face of inflation risk, thus increasing the yield represented by its market derived interest rate. That the price and the yield of any commodity is subject to the same market forces, dare I say it as a socialist, is inevitably true. 

    The market will continue to shift costs based on the perceptions of buyers and sellers. We cannot easily predict which way costs will shift in the future, but the market price today represents the best collective human prediction of that shifting. Politics, greed, and the perception of morality will continue to shift. Collateral sources are simply a force in future cost shifting,which will be priced into the market after the current wave of cost shifting has run its course, and the new wave of cost shifting enlightens the minds of those in power to the  belief that they can produce a favorable outcome for themselves based on whatever cause celebre possesses their greedy little egos at the time. 

    Collateral source discounts do not change the cost of an item, they simply shift it to someone else, resulting in a cascade of reciprocal shifting. Never forget, TNSTAAFL. (There's no such thing as a free lunch). 

    ------------------------------
    Kent Arnold Jayne
    President
    kentjayne@sprynet.com
    Cedar Rapids, IA United States
    ------------------------------




  • 19.  RE: Collateral Sources in life care plans

    Posted 08-10-2015 16:01

    So are you suggesting that we ignore jurisdictional requirements? How, specifically, would you present your costs when you know that the court requires different costs? I am struggling with comments that suggest that we set our own rules when, in fact, we have chosen to play in someone else's setting.  "Market value" is not ours alone to define.


    ------------------------------
    Karen Preston, FIALCP
    Consultant
    rnsconsult@aol.com
    Sacramento, CA United States
    ------------------------------




  • 20.  RE: Collateral Sources in life care plans

    Posted 08-10-2015 17:18

    This is so very timely and I expect we will discuss this more at the upcoming Summit and Symposium in Scottsdale in less than 6 weeks.

    Maybe we collectively will arrive at consensus statements for the practitioner to rely on when educating those who request our services in the topics of Best Practices in Transparency and best Practices in Business and/or have the dialogue during the Sunday morning session on Collateral Sources.

    Looking forward to seeing you all there!!


    ------------------------------
    Cloie B. Johnson, MEd
    Rehabilitation Counselor/Case Manager

    OSC Vocational Systems, Inc.
    Bothell, WA 98011

    425-949-4406
    206-666-2748 fax
    ------------------------------




  • 21.  RE: Collateral Sources in life care plans

    Posted 08-10-2015 17:22
    Cloie, that is an excellent idea. There is so much misinformation out there.  This would a doable project and really helpful.

    See you at ISLCP.

    Peeps

    Caragonne and Associates, LLC

    Mexico Office: 

    79 Calle Hidalgo
    45920 Ajijic, Jalisco
    Mexico


    Fedex or UPS Document Packages:

    Penelope Caragonne, Ph.D.
    Sol y Luna Logistics
    Plaza 
    Bugambilias #54 Local 4

    #71-388
    Jalisco, 
    45920 MX  

    US Mail Forwarding:

    Penelope Caragonne, PhD.
    827 Union Pacific Blvd., 071388
    Laredo, TX  78045


    Website: www.caragonne.com
    Email:    Mail@Caragonne.com
    1-866-285-0665   Toll-Free US
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    On Mon, Aug 10, 2015 at 4:18 PM, Cloie Johnson via IARP Connect






  • 22.  RE: Collateral Sources in life care plans

    Posted 08-10-2015 18:05

    This is all so timely, since the next Journal of Life Care Planning is due out by the end of August and there happens to be a comprehensive article in there focused on collateral sources and the affordable care act. Please take time to read this article, as well as the others, to help educate us to participate and get the fullest benefit out of the Summit and Life Care Planning Conference.

    See you in Arizona.

    ------------------------------
    Dianne Simmons-Grab, MA, CCM, CDMS, CLCP
    diannecsg@thesgassociates.com
    Ridgewood, NJ United States
    ------------------------------




  • 23.  RE: Collateral Sources in life care plans

    Posted 08-10-2015 17:34


    I agree with Karen. There is just no way a planner can ignore jurisdictional requirements. This is an area a life care planner has to research in order to offer credible testimony.  I suppose a life care planner could just blithely offer up that their costing methods are somehow divorced from this jurisdictional issue, but I don't think its a credible argument any longer. I think we should be looking at the precedents in each state we testify. I think the idea that we can use our own rules destroys the idea that  generally accepted methods and standards should under-gird our care plans.  Now, how we arrive at that will be interesting, but I think we all need to consider integrating additional jurisdictional research before we present a set of costs. Looking forward to ISLCP!  I think this will be a fun conference. 

    Penelope

     
    ------------------------------
    Penelope Caragonne, CLCP
    mail@caragonne.com
    Laredo, TX United States
    ------------------------------




  • 24.  RE: Collateral Sources in life care plans

    Posted 08-10-2015 17:38
    Cloie, et al:

    One of the policy statements I hope to see come out of the Summit concerns the use of life expectancy tables and the application of race and gender-specific data. There have been a few federal court cases where the court took an expert to task for using gender and race-specific data that lowered one's life expectancy compared to other data.  As we know, federal court judges often do whatever they want to do with issues like this.  I would like to know what our colleagues recommend doing where the court is silent on the issue.  

    This is one of the benefits of the summit.  The policy statements can be SO helpful to all of us.

    Thanks.

    Bob

    Robert H. Taylor
    4745 Tanglewood Trail
    Boulder, CO 80301-3928
    (928) 713-6833










  • 25.  RE: Collateral Sources in life care plans

    Posted 08-15-2015 10:59
    I concur wholeheartedly with Bob

    Alex Karras JD,OTR,CRC,CCM,MSCC,CLCP
    Diplomate American Board of
    Disability Analyst
    Owner
    Alex Karras Consulting
    1659 Brook Ln.
    Jamison Pennsylvania 18929
    Cell 215-530-5041
    Fax 267-224-4486

    Sent from iPhone and likely dictated using Siri so please excuse typos.






  • 26.  RE: Collateral Sources in life care plans

    Posted 08-10-2015 19:29
    I agree fully with karen.  This is not our decision to make.  It is a legal issue 

    Mona Yudkoff, RN
    BalaCare Nursing Solutions
    610-664-8760






  • 27.  RE: Collateral Sources in life care plans

    Posted 08-10-2015 20:00

    Karen...right or wrong, I agree with you.  It is my feeling that we can not just ignore jurisdictional mandates and must be ready to play by those rules.....the session on the Affordable Care Act Impacts at the up coming IARP Life Care Plan Conference in Scottsdale, AZ should be enlightening and lively!!! 

    ------------------------------
    G. Michael Graham
    Consultant, President
    gmgedd@yahoo.com
    Kapolei, HI United States
    ------------------------------




  • 28.  RE: Collateral Sources in life care plans

    Posted 08-11-2015 01:05

    Hello to Jurisdictional believers,

    The only way I can see that one can answer this concern is in this way:

    One would need to take a sample of say 10 discounted items.... and say these are all possible and also show say 10 companies that did not provide discounts and tell the jury, if you feel the evaluee will luck out and find the company with the discount then that would be the answer...but this is a very weak argument, there is no reliability, will the discount still be there next week, next month, or at all?... but that is what the jurisdictional believers are saying - we must follow something that is not guaranteed and say with our righteous tone of voice...you must find a discount figure, because our religious & political state says you must.  OK at this time, on this date there was a discount.  (whats wrong with this statement - the evaluee gets the raw end of the deal - we will all become defense experts no unbiased experts - because religion and politics rule.  And again the good name of rehabilitation will be used as a claims management tool - how nice - it has a nice ring to it and my gosh the LCP professional said it with his/ her integrity just glistening on their halo.

    Next provide 10 examples of what one party of the state did with medical concerns and find 10 items where the other party impacted medical concerns.  Jurisdictional believers want an answer.  What if the State changes their congressional districts and actually makes gerrymandering not legal - at present there is a push for this action in States across the USA.  I live in Michigan and the League of Women Voters is having 30 town meetings regarding gerrymendering through out the state this Fall.  Do you want to be on the side of the Jurisdictional Believers that say we must make a choice.  I say no.  "We can all take a stand and say we will not take part in this"   There was a time when blacks had to sit in the back of the bus, children worked in factories, women were not allowed to do certain jobs, ....there were many wrong laws made by politicians influenced by unsavory, or just plain ignorant folks that wanted their views to be heard over doing the right thing.  We know what the right thing is, why would you want to throw that out.  This is no different than a labor movement...we need to do the right thing as a group and not give in to baloney thinking.

    ------------------------------
    Ronald Smolarski
    Director
    ron@beaconrehab.com
    Ann Arbor, MI United States
    ------------------------------




  • 29.  RE: Collateral Sources in life care plans

    Posted 08-15-2015 10:39
    Hello Colleagues,
    I do not pretend to understand all aspects of the collateral source issue, as it is an evolving one. However, my 2 cents would be… I strongly believe the life care plan must stay true to it's purpose of providing the cost of obtaining the goods and services in today's market. 

    I am hearing in this discussion that some states are saying "collateral sources must be considered in settlements," but, is anyone saying they are being told, "collateral sources must be considered in the life care plan?"

    What is done with the life care plan after it is produced is up to the attorney. It is processed according to the law. For example, they send it to the economist to calculate inflation or to a Medicare set-aside specialist. There may need to be a specialty for evaluating what would be covered by the Affordable Care Act coverage, but, I am not that specialist. Unless the law is saying the "life care plan" must consider collateral sources, I would suggest that we consider keeping the life care plan pure to today's market value, and yet accept there may need to be another step, by another consultant (the attorney coordinates), in order to provide a final product usable to the court.  I look forward to learning more…

    See you in Phoenix!

    Amy Johnson Mackenzie, PhD, RN
    Certified Life Care Planner

    3602 Canyon Creek Circle
    Tyler, Texas 75707
    (903) 595-6777 Phone
    (903) 595-6779 Fax
     amy@johnsonclcp.com
    JohnsonCLCP.com







  • 30.  RE: Collateral Sources in life care plans

    Posted 08-15-2015 12:26

    Well said Amy!

     

     

    Bob A. Gisclair, MS, CRC, LRC, LPC, CCM, CDMS, CLCP, MSCC, CMSP

    Gisclair & Associates

    10101 Siegen Lane, 2C

    Baton Rouge, La. 70810

    (225) 768-7282

    Fax (225) 768-7284

    boba@gisclair.com

    www.gisclair.com

     

     

     






  • 31.  RE: Collateral Sources in life care plans

    Posted 08-17-2015 15:52

    Please be cognizant that this discussion has included a tangential conversation on what determines "market value", not just collateral resources. The difference is "what it costs to obtain" versus "who else can pay for it?".

    Market value is a separate concept from collateral sources.  Market value is defined in many ways, so we need to be aware of what definitions apply to the case situation. It could be the usual and customary charge or it may be something else; the "cost of obtaining goods and services" is not cut and dry, and yes, in some cases it is determined by law.

    As we approach the Summit next month where these may be discussed, we need to consider that our opinions about market value and about collateral resources are different discussions, and they should not be blended or confused.

    ------------------------------
    Karen Preston, FIALCP
    Consultant
    rnsconsult@aol.com
    Sacramento, CA United States
    ------------------------------




  • 32.  RE: Collateral Sources in life care plans

    Posted 08-15-2015 11:02
    Will put Ron

    Alex Karras JD,OTR,CRC,CCM,MSCC,CLCP
    Diplomate American Board of
    Disability Analyst
    Owner
    Alex Karras Consulting
    1659 Brook Ln.
    Jamison Pennsylvania 18929
    Cell 215-530-5041
    Fax 267-224-4486

    Sent from iPhone and likely dictated using Siri so please excuse typos.