By: Karen Piso Nadeau, Esquire

The Problem of Timely Needed Medical Care

We have been dealing with more and more clients injured in accidents who are unable to get the medical care that they need. There are long waits to see their primary care doctors. Some have no primary care doctor, and the wait lists are months or even more than a year to establish care. It is taking some clients months to see a medical specialist such as an orthopedic doctor. They are on waiting lists at physical therapy locations. Some clients have mental health issues from the trauma of the accident such as anxiety and post-traumatic stress and can’t get in with a psychologist or therapist for months. Some of these victims feel helpless and suffer without treatment for months. They don’t know what to do. This is not only bad for their health and well-being, but from a plaintiff personal injury lawyer’s perspective, it may be detrimental or even fatal to a personal injury case and getting the client the money that they deserve for their injuries due to the wrongdoing of others.

Insurance Company’s Perspective

When deciding how much to pay a victim harmed by their insured, an insurance company relies heavily on the medical documentation from the medical providers that see and treat the injured person. They look at the dates of service, how often they treat, the type of treatment, the diagnosis given, the length of treatment, and the medical notes generated by the medical provider. When there is a lack of medical documentation, the insurance companies love this as this gives them reasons to pay a victim less on a settlement. The current situation in Massachusetts where injured people can’t get appointments with needed medical providers unfortunately helps the insurance company’s goal of paying an injured victim as little as possible on a personal injury case.

During my years of practice, I have seen insurance companies also argue the opposite position to marginalize a case, that the treatment was excessive or not needed. Currently, my experience is the injured party is not treating enough and is not getting the treatment that they need due to the current saturation of our health care system in Massachusetts.

 Difficulty Accessing Medical Care in Massachusetts

If you are having difficulty getting a medical appointment, you are not alone. There are long wait times and difficulty accessing medical care with Massachusetts facing a shortage in primary care doctors. According to a report from Massachusetts Health Policy Commission (HPC), in 2023, 41 percent of MA residents reported difficulty accessing care and an inability to get an appointment in a doctor’s office when they needed it. HPC found in a recent report that wait times for new patient appointments were more than twice as long in MA than other states. NBC 10 Boston reported that some patients wait months or even up to a year to see a primary care doctor. These delays could lead to worse health outcomes.

HPC states several factors for this shortage including current challenges in primary care with reimbursement modes from insurance, administrative burden, patient portal emails, prior authorizations and billing and coding documentation. This takes a lot of time. Programs are being used to take advantage of technology to decrease the burden on providers.

Helpline operated by Healthcare for All assists MA residents in enrolling in health insurance. They see people feeling lost and don’t know where to go. Again, this supports the difficulty getting a doctor’s appointment. Also, WBUR News reported that primary doctors and pediatricians had longer workdays going on 12 hours a day forcing them to limit new patients. When a patient can’t get an appointment, they sometimes resort to the emergency room or urgent care that are already overcrowded.

At Dimock Center in Roxbury, MA, the co-medical director at Dimock NP Grant Butler stated that patients wait up to 3 months for a first appointment. Full-time primary care doctors at Dimock see 80 patients a week on average and a good portion of this is managing chronic conditions.

Supply is not meeting demand. To help solve this problem, health care professionals believe that there is a need to focus on primary care and investing in it. Most money goes to hospitals and prescription drugs. The focus should be on preventive care versus waiting until you are sick.  Some of the factors raised for the primary care crisis include lower pay and retirements leaving patients without a primary care doctor.

 Some Suggestions for Getting the Medical Care You Need

1. Don’t wait and let time slip by. Make getting a medical appointment top priority in your life.
2. Don’t be passive and wait for the medical provider to come to you. You know the saying about the squeaky wheel. Sometimes you need to be the squeaky wheel but always be respectful in your communications with the medical provider.
3. Get the first appointment you can get, even if it is 2-3 months out. Once you secure this appointment, you can then turn your attention to reaching out to other providers for an earlier date. You can always cancel an appointment that is too far out once you get an earlier appointment.
4. Call other offices. For example, if the physical therapy place gives you a first appointment one month away, take it. Then call other physical therapy places for an earlier visit. It takes some time and commitment, but many of our client are successful doing this. Be sure to cancel any appointment you no longer need.
5. Get on a waiting list at the medical facility. Then follow up with the medical facility to see where you are on the list. Sometimes making that follow up call gets you in. There may have been other cancellations or a doctor’s schedule opens.
6. Communicate the urgency of your healthcare needs to the medical provider, again respectfully.
7. Sometimes your primary care doctor may help get you in with a specialist sooner or get you an earlier physical therapy appointment. It does not hurt to ask for help getting you in sooner.
8. If you can’t get an appointment to address your injuries in an accident in a timely manner, urgent care and the emergency room are options to make sure you get the medical attention you need. They may order x-rays, labs, other diagnostic testing, refer you to a specialist like an orthopedic, or refer you to a physical therapist.
9. Reach out to friends, family, or your local community for help. They may have some doctors’ names or medical facilities for you to consider. I see people on Facebook local community pages asking for the names of primary care doctors, specialists or other medical providers.
10. Don’t give up and talk to a personal injury lawyer if you have been injured in an accident through no fault of your own. An experienced personal injury lawyer can help guide you during this difficult time.

Get the Medical Attention You Need & Advocate for Yourself

My best advice is to get the medical attention you need as soon as possible if you have been injured in an accident. I have a front row seat to many injured people not addressing their injuries because they are frustrated with trying to get medical visits and did not know what to do. Sitting home on the couch for a month with difficulty breathing and pain in your ribs with no medical care should not happen. X-rays may show fractured ribs. Walking on a leg that is unstable and painful may be doing more harm to you if there is a broken bone or other injury and you need crutches or a brace or other medical care. These are real examples of real clients who could not easily navigate the health care system in Massachusetts to get a doctor’s appointment.

From the personal injury lawyer’s perspective, not getting medical care that you need may severely negatively impact your case. You need to know your injuries and have a diagnosis and a plan of needed medical care that is implemented. Getting the medical attention that you need is essential in pursuing a personal injury case. Insurance companies are in the business of not paying claims or trying to pay as little as possible. They will no doubt take full advantage of the present medical care crisis in MA that prevents injured parties from getting the medical care they need easily and use this to pay out as little as possible on a case. The only way to stop this is to be persistent and make sure you get the medical care that you need if you have been injured in an accident.

At Nadeau Harkavy LLC, we have over 60 years combined experience representing injured people and their families when they have been involved in a motor vehicle accident, trip and fall or other type of accident. We have recovered millions of dollars in compensation for our clients over the years to help them get on with their lives after suffering the consequences of a serious accident.  We make sure everything is done to protect your interests while you and your family concentrate on getting better. We handle all types of car accident cases including wrongful death, spinal injury, and brain injury. We represent drivers, passengers, pedestrians, bicyclists, as well as other types of car accident cases such as scooter, motorcycle, and skateboard cases. We also handle other types of injury cases such as trip and fall, slip and fall, dog bite, construction site, and catastrophic injury accidents. If you or a loved one has been harmed through no fault of your own, call us today for a free consultation about your legal rights at 617-674-7640.