Certainly the doctors office requiring a signed stipulation to pay for a no-show is out of line and not supported by any regulation that I know of. That’s like trying to catch flies with vinegar instead of honey. It would probably also get the doctor at least a nastygram from the Administrative Director if she heard about it.
In the rare instances where I have had no-shows, I have found that insurers typically will pay for at least one or two hours of QME time, since a psychological QME requires me to set aside at least a half day to accommodate the injured worker given the time needed for detailed intake plus psych testing. Most adjustors understand this, and pay up at a reasonable level. Usually if a re-schedule is made, and the applicant shows for that, then I don’t bother with a billing for the no-show.
I also have found IC’s are willing to pay for the time for review of records that they have sent me and asked me to review, even if there is a no-show. I don't think I have ever had a company refuse to pay for at least one hour, plus records review time, if any. When the adjustor has sent me 400 pages of records to review, it only makes sense that I am compensated for the review time, even if the injured worker does not show. Usually though by the time there are 400 pages to review, the applicant shows as they are quite dedicated to their case.
I have found that the larger the case file, the more certain the injured worker will present for the evaluation. It's those 30 pagers or no records that will be a no-show.
I did have an exception earlier this year, in case with a large case file. In an unrepped case, the Adjustor made the appointment. The injured worker kept calling my office late at night and saying that he had decided not to attend. This happened several times. Each time this happened, I faxed a notice of this to the Adjustor, asking if I should cancel the appointment. In the final fax, just days before the eval, I asked if she was sure I should not cancel, as the applicant seemed to clearly be stating they would not come. I stated in the fax that I would be glad to cancel with no billing to ensue, but that I would be billing for the 4 hours set aside for the appointment, plus the several hours of records review, if the adjustor kept the appointment in place and the client no-showed. The adjustor faxed back saying not to cancel, that they were telling the applicant to attend. The applicant no showed, and the adjustor paid up for 6 hours with no problems.