Many of my readers may recall previous articles concerning Unum’s paid physician reviews and what are called, “doc-to-doc” calls. Unum’s agenda for the calls is to persuade treating physicians its medical review is the only accurate one, and patients can return to work.
Recently, it came to my attention that a Unum physician was successful in getting through to a treating physician three times! This particular patient previously told the physician that she did not give permission for her doctor to speak to Unum on the phone. Despite the patient’s wishes, her physician went ahead and communicated with Unum’s doc resulting in a premature return to work.
Here is Unum’s agenda for making doc-to-doc calls. And, by the way, Unum is by no means the only company who uses this strategy even though Unum’s doc-to-doc abuse was documented by the Multi-State regulators.
- Unum’s calls attempt to persuade treating physicians that its review results are more accurate than his/her opinions.
- Unum continually mentions reviewers are board certified, trying to intimidate your doctors with higher credentials. (I don’t know why they do this anymore since nearly all physicians are “board certified.)
- Unum attempts to obtain “return to work releases” to have more than one consensus of opinion to back up return to work denials.
- Buy ins from treating physicians that patients can go back to work always make it through the appeals process and litigation.
- Unum makes the calls near profit quarters and month end in order to bolster profits.
- Unum’s physicians are rewarded with monetary incentives for their success in obtaining return to work releases. (March 2020)
- Unum’s doc’s use doc-to-doc calls to send the message that it disagrees and costly litigation may be around the corner.
- Unum sends out faxes after phone calls “documenting what was said”, most of which was never said. Physicians who do not correct these faxes or take the time to respond are put on record as agreeing with Unum.
- Doc-to-doc calls are profitable strategies to deny more claims.
Let’s not sell Unum short. It’s physicians leave their ethics at the door each morning and do whatever is necessary to assist management with its agenda to deny more claims. Unum still employs the old “claim killer” physicians to review files and make these calls such as Dr. Ursprung, who sends out narrative questionnaires to treating physicians trying to encourage return to work.
In my opinion, Dr. Ursprung is a well-known Unum medical reviewer who rarely decides in favor of insureds – it’s no secret anymore, most attorneys and consultants who work in the industry are well versed about Dr. Ursprung and his biased reporting.
They are paid handsomely for this with salaries way above $100,000 + annual incentive each year. Unum’s misrepresentation of medical information has a way of jumping off a medical review page into a phone to a treating physician who is intimidated, scared, and more willing to agree with Unum than not.
In short, doc-to-doc calls are claim recipes for disaster. HIPAA, a federal regulation that supposedly protects the electronic transmission of patient data, also includes phone exchanges regarding patient health. For a long time, physicians refused to take calls from insurance companies fearing HIPAA violation of transmission of information.
Why treating physicians are once again going behind their patient’s backs and communicating with Unum on the phone, even when patients say, “I do not authorize verbal communications”, is beyond me. At the same time, treating physicians are also directly faxing information to Unum (other insurers as well), despite patient requests to see what is sent first (other than patient notes).
One possible reason is that physicians are taking the shortest distance between too points because they are busy and just want the problem to disappear. But, I don’t buy that. Physicians stand to lose patients and fees, by disregarding patient disclosure requests.
I am of the opinion that Unum’s physicians have become very clever with their persuasions that also challenge patients’ credibility. Surveillance DVD’s are, on occasion, sent to treating physicians to review, followed by a phone call. If the visual evidence is persuasive, most treating physicians will release patients to return to work. It’s that simple.
Although I’ve found that most treating physicians today finally understand Unum’s and other insurers’ motives in making doc-to-doc calls, some still violate patient requests and speak with Unum on the phone. Thankfully, the majority of mental health providers are making it policy not to release actual psychotherapy notes.
Patients have the right NOT to authorize physicians to speak on the phone with Unum or any other insurance company. This request can be easily written in on the HIPAA Authorizations physicians ask patients to update on a yearly basis in their offices.
It might be a bit different if Unum’s motive in contacting treating physicians was honest and in good faith, but they are not. There is always an agenda associated with the calls, which is to persuade treating physicians to release patients to return to work.
It’s Unum’s opinion against that of your physicians. Insureds do NOT have to allow it, and physicians who do it without authorization should be held accountable with HIPAA violation complaints.
One situation to be particularly wary of is the possibility of a doc-to-nurse manager call, which happens quite frequently. Unum calls your doctor’s office manager who does not bother to consult your file, and releases you to work on Unum’s say-so. No matter what your doctor does beyond this point to say, “it was a mistake”, will not matter because it won’t be credible.
While I understand the reluctance of insureds to make waves with their doctors, it won’t feel very good to find out your treating physician threw you under the train by releasing you to return to work behind your back. More and more physicians are taking calls from Unum resulting in denied claims.
I strongly recommend having discussions with your treating physicians on your next visits to remind them you are NOT giving permission to speak with Unum, or any other insurance company on the phone. They may or may not abide by your wishes, but the remedy is to file a HIPAA complaint, which no doctor wants either.
