Disability Claims Solutions

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physicians walk around youMost treating physicians really care about you and your disability. They and their staffs spend extra unbilled time to meet the requests of insurance companies, and generally assist insureds in every way they can. However, treating with physicians who have your best interests in mind is not a universal trend. Unfortunately, some physicians feel obligated to cooperate with insurance companies regardless of the wishes of their patients.

Patients with disability claims can discuss with their physicians what actions can be taken, or not taken, when contacted by insurance companies. After all, patient records are confidential, and doc-to-doc calls are subject to “electronic transmission” regulations under HIPAA. For this reason alone many physicians are refusing to speak with insurance physicians about their patients.

However, for whatever reason, there are treating physicians who, despite what patients request, communicate with insurers, fax information directly to the insurance companies without you seeing it first, and basically pick up the phone and call insurance docs to provide information about you. In some cases, physicians have been known to communicate with insurers even when patients have expressly said, “I don’t give you permission to do that.”

Why? Discounting the possibility of “God complex” in some physicians, it seems more reasonable to me that physicans might be communicating information to insurers that they aren’t telling you. Doctors today may feel as though you can work, but have a hard time explaining that to you. In other words some physicians will not share their true feelings with patients, but have no “hold back” with insurance companies.

Treating physicans who walk around their patients for disability reporting are hiding something, at least in my experience that has been the case. There is something wrong with a treating physician who knowingly speaks with insurance physicians while most of his/her peers are rejecting phone calls from the insurance industry.

Although patients have the right to see any paperwork submitted to insurers in advance, some physicians refuse that request and immediately fax the paperwork directly from their offices. In fact, I’ve known a few physicians who refuse to provide patient notes directly to patients when requested to do so.

Although I am not one to immediately suggest patients separate themselves from their treating physicians, it is true that physicians who reject reporting procedure requests from patients are not beneficial to insureds with disability claims in the long-run. Likewise, physicians (and office nurse managers) who balk at filling out forms, or begin to “grumble” about insurance reporting, or tell you, “We already faxed that information from here”, are likely to cause more insurance problems than they solve.

Disability insureds need to move on when these things begin to happen. Sometimes treating physicians will never tell you their real recommendations and insurance problems begin. Although searching for new treating physicians is difficult, insureds need to move on and take their medical care to some one else.

I can’t tell you how many times a nurse manager filled out an update form without checking the patient’s record, giving work capacity including a work release, only to find out that was not the intent of the treating physician. Had the patient been given the opportunity to review the forms first, the mistake could have been prevented.  Unfortunately, once a report like that is submitted to an insurance company, wrong not not, it is nearly impossible to take back.

I’m not sure why, but disability claim patients often seem more willing to “put up with” a doctor who seems to hide communications to insurers, than to activity seek out physicians who are more willing to share completed paperwork before it is sent.

My recommendation is for insureds to search for new treating physicians who are more willing to complete paperwork and share the results before faxing to the insurance company. Physicians and their staffs who are cooperative in working with patients for full disclosure are more inclined to treat patients more effectively for longer periods of time.

No patient need tolerate treating physicians who deliberately walk around their patients when providing medical information to insurers. I would want to know what’s being reported. Wouldn’t you?