Interpreters, new en banc (California) (California)

[stewshe]

There is a new en banc decision dealing with interpreters: Guitron vs Santa Fe Extruders and SCIF

http://www.dir.ca.gov/wcab/wcab_enbanc.htm

Seems reasonable to me, despite the arguments it is not "covered." Anyone who has been sick or injured in a foreign country where the medical staff do not speak English will appreciate the wisdom of the decision as to "medical necessity" from the patient's point of view.

Stew

[jpod]

The sad thing is in many cases valid interpreting services are required. But unfortunately there are those out there who abuse it. I once had a treater in Santa Barbara who had an onsite interpreter who would interpret for the doctor. When I looked into the arrangment I found that:

-the doctor was renting space in his office to the interpreter;
- the interpreter's bill for each office visit was nearly twice the bill for the doctor's office visit;
- the doctor recieved a percentage of the interpreter's billings in addition to the rent;
- each office visit lasted about 15 minutes;
- the interpreter did not travel to any other office locations, only did interpetting services at this one doctor's office;
- services were provided for patients all day long.

There was no doubt intrepreting services were needed. But I asked the interpreter how she could justify charging more than the doctor charges for the same office visit. I mean after all she was merely intrepreting for the doctor, why would her time and work be worth more than the doctor's time and work. She had no answer other than to say that some of the money goes to the doctor which is how I discovered the true nature of the arrangment.

[stewshe]

jpod,

Agreed! The main problem is there are a few "bad apples" which tend to "spoil the barrel" for the rest.

Mills, like the one you describe, need to be prosecuted for fraud, etc., to discourage copycats in the future.

It is a shame so many EEs over the past decades have been unable to get interpreters for their medical appointments. They have had to pay bi-lingual persons exorbitant amounts to provide the assistance which should have been paid by the carrier. But also, they should be learning English.

Over the years I have heard horror stories from EEs and even co-workers who grew up in Mexico in rural, one room, dirt floor houses who are now American citizens (the test to become a U.S. citizen could not be passed by at least 90% of the population of the U.S. including most college graduates). These people remember how difficult it was for the first few months living here, and how often they were taken advantage of by these "interpreters."

I am a strong believer in learning the "local language" when you are in a foreign country. When I was stationed in Germany for 3 years, I learned to speak German. I couldn't read a newspaper, but I could drink beer and discuss sex, religion and politics (seldom the latter two, I admit).

Near the end of my tour, I can recall a G.I. in Trier asking me for directions . . . in truly miserable German. I answered, in German, and drew him a map.

A friendly "local" overheard me and asked me why I didn't tell him in "American," since, of course, I had an accent. I told him I wanted to encourage the G.I. to continue to learn German, just as I had. He agreed.

Stew

[jonbrissman]

Let's examine the complaint that an interpreter's charge is more than a physician's charge. Here's why the comparison is unfair:

An interpreter must appear with the patient at the appointment time, spend time with a nurse or doctor's-office clerk to get the paperwork completed, wait for the patient to be called, and then accompany the patient to the examination room. Often a doctor runs significantly late and the actual meeting occurs long after the scheduled appointment time. The interpreter must wait all that time with the patient. If an interpreter spends two hours total at a medical visit, the fee schedule allows $90.00 (or more if market rate applies). The doctor who spends five minutes with the patient is compensated $23.35 (CPT 99211, simple visit, established patient). Of course, the doctor bills a dozen or two of those office-visit charges while the interpreter is waiting with a particular patient. Compare what an interpreter charges to what a physician charges for the same amount of time[u].[/u]

So isn't an interpreter who spends two hours, for example, entitled to a greater fee than a physician who spends just a few minutes?

JCB

[jpod]

Not in my case, the intrepreter is with the doctor doing another exam while my employee is waiting for the doctor. And if no exam is going on the intrepreter is sitting at her desk or doing other work for the physcian, being paid by the hour. The charges for intrepreting are stand alone charges and is on top of the hourly wage the employee was earning too.

[stevepsca]

Seems reasonable to me, despite the arguments it is not "covered." Anyone who has been sick or injured in a foreign country where the medical staff do not speak English will appreciate the wisdom of the decision as to "medical necessity" from the patient's point of view.

Agreed...but I just have a question/s...
IF an interpreter is needed, either medical, depo, med/legal, hearing/trial... isn't it required the IW notify/request from the CA prior to the appts. ?
If that's the case, why is jpod's Dr providing the services, why isn't the CA contacting the service provider ? Agree with jpod there is 'something fishy' in this arrangement, and should be prosecuted as fraud if the evidence suggests.

[stewshe]

stevepsca,

As a general rule, knowledge of the employer is imputed to the insurer/adjuster. Presumably the ER knows whether or not the EE is, e.g., Spanish or Korean speaking, etc.? For example, from my book under "Knowledge of Injury," page 487:
<<
• Employer’s knowledge of injury imputed to insurer: Insurance Code §11652; CEB
§12.13; CWCLP §13:240
>>
The last cite is for Judge St.Clair's book, "California Workers' Compensation Law and Practice," though there are now other co-editors/authors I believe.

In my other life as a claims examiner and then supervisor some 30 years ago, we had a 24 hour contact policy. We didn't always meet this goal, but we tried. Often our first notice was a call from a doctor's office or receipt of a Doctor's First Report. If treatment needed was beyond 1st aid or TD was involved we had people calling the ER and the EE for additional information, prognosis, etc. Files were flagged if the EE could not speak English and arrangements for interpreters were made if needed.

Sometimes, when there were serious issues, a doctor would request an interpreter to be certain there was good communication with the patient. Other times an EE would request one when for one reason or another a family member was not wanted to be present. I do not recall ever objecting to such a request.

Stew

[stevepsca]

Thank you Stew...

Everything you are saying is "reasonable", and refers to "requests"...and I think is only good claims administration.
Prior notice to the CA of the necessity of a interpreter.
It would stand to reason the CA would know what's coming down the pike in fees/billable hours.

I'm not sure the Dr jpods scenario is even acting in 'good 'faith'. Even Dr's writing a Rx must notify a patient of their financial interest in the pharmacy downstairs, or Rx for PT in the ''in-house'' facility. Giving the patient the opportunity to use another facility.

This Dr providing 'in-house' interpreative services... reeks...of what, I'm not sure.

It just seem to me, where everything provided to an IW... is subject to prior authorization, interpreters would be among those ''benefits''.

Thanks again...

BTW... in reading the Title 8 CCR...http://www.dir.ca.gov/t8/9795_3.html, I think maybe jpod got off easy on the fees in the scenario presented. lol.