Disability Claims Solutions


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Missing documentsAs most of my readers are aware (hopefully…), disability insurers have outsourced most of the functions required to investigate claims, including medical and occupational review, financial review, and “paper chasing.” Notable companies are PMSI, EMSI, and more recently Release Point.

Release Point, in my opinion, is one of the worst reliable third-party “paper chasers” in the country. Unfortunately, many disability insurers have contracted with this company and it is causing major problems with delayed paperwork. Claims handlers rely on requests to Release Point to obtain medical patient notes, but in my experience, most of the requested information is never obtained – at least not in a timely way.

Release Point obviously has not been “filled in” about Plan and policy time requirements. DCS, Inc. has been notified on several occasions that RP requested medical records from treating physicans with a deadline of 1 week!

RP’s letters were threatening to physicans who basically refused to provide anything at that point. Plan and contract language allows 30-45 days to provide “proof of claim, while IDI policy provisions allow 90 days after any claimed period of disability. These provisions extend to treating physicians and it is entirely inappropriate to demand paperwork on a short-deadline.

What really bothers me as a Consultant is that anyone involved with the insurance industry knows that most treating physicians WILL NOT BE ABLE to provide patient notes within months, sometimes, much less one week. Is Release Point out of touch with the industry? Or, is it the insurers respoonsibility to inform Release Point of Plan and policy provisions so that the company can request medical records consistent with Plan and policy requirements?

The end result is usually a mess, and when medical records are not received, claims handlers send out letters asking for help in obtaining the records, now a huge waste of valuable time for insureds looking for timely benefits.

Release Point also has a very definitive flaw. The company asks insureds to sign multiple authorizations, one for each medical provider. In one instance my client was asked to sign 12 separate Authorizations to obtain medical records from multiple sources.

When Authorizations are not signed, many of the companies including RP make phone calls every day “to follow-up” – a very annoying process. Why can’t the company just list all of the medical providers on one Authorization and  use it? I asked that question to one of RP’s employees who told me, “We have to follow the rules.”

PMSI and EMSI aren’t that efficient either and cause a great deal of confusion when requestiing medical documents. None of the third-party paper chasers have any success in obtaining medical paperwork in a timely way from state HMOs such as Kaiser and Loma Linda, Mayo Clinic etc. In the meantime are waiting and waiting for insurers to obtain paperwork that will take another 45 days to review once its received.

Therefore, DCS, Inc. recommends that all  insureds obtain their own patient notes and forward them to the insurance company. Do not wait for Release Point, EMSI, or PMSI to request records.

The above named third-party paper chasers make the update review process so much worse that insureds are better off requesting their own records.

Given the current crisis where treating physicians are closing their doors to direct contact, you can imagine that Release Point and the other companies will come to a standstill with obtaining patient notes. I can’t give a recommendation because one size does not fit all in this situation.

DCS, Inc. recommends that insureds work with their doctors to obtain records whenever they can be made available. As in my prior posts, insurers are working with insureds to extend deadlines and allow for the current crisis to pass.

Still, I continue to recommend to insureds that they obtain their own patient notes to expedite reviews and timely decisions.