Two of the most important ERISA Group Plan provisions require claimants to submit medical and all requested information “at their own expense” and “within 30-45 days of it being requested.” This is very much a standard provision in all group Plans regardless of insurer. The 30-45 day time frame also applies to treating physicians when requests are sent directly to them.
Release Point is Unum’s third-party paper chaser, and in my opinion the company operates in robotic fashion. I’ve spoken to a few handlers at Release Point, and they’ve shared that they are required to follow-through on a set of standard procedures no matter what.
I originally called them asking why they sent out 10 separate Authorization forms with one doctor listed on each form. Normally, all treating physicians would be listed on one authorization that could be copied and sent at one time. “We can’t do that”, said the handler I spoke to, “this is just the way we do it.”
Another of Release Point’s procedures includes sending treating physicians requests for records with a deadline of one week! A threat is also made that if the records aren’t received in one week, benefits will be suspended. These letters are harassing physicians and I’m hearing that claimants are taking the “1 week timeframe threat” seriously. However, nearly all employer group Plans require records to be sent within 45 days of the date of the request.
The important thing is for Unum’s claimants to point out (attaching a copy of the provision to the fax) that their Plan allows up to 45 days to submit additional information. It is unreasonable for Unum, and its representatives, to require physicians to send records in one week. It’s not going to happen; it’s out of Plan; and not possible for most treating physicians.
Unum’s claimants have a right to request from both Unum and their employer that the Plan provisions be enforced. And what’s with all the threatening of treating physicians and their patients (claimants)? Is that really necessary?
Please look in your Plan for the provision requiring you, the claimant, to submit proof of claim within 30-45 days of Unum’s request. Some of the older policies say 30 days, the newer ones, 45 days.
Then, stand on the provision and inform Unum you will be happy to provide the requested information, but by the timeline stated in your Plan. Ask the claims handler to inform Release Point of the Plan’s time limitation of 45 days, and stop the frequent requests to both you and your doctors.
This is not something you or your treating physicians should continue to put up with. Not too many physicians will put up with this long-term.
