Disability Claims Solutions

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Do TeleHealth meetings with my doctor count for disability purposes?

Yes, they do. Physicians are keeping patient notes of TeleHealth meetings whether internally or managing patient visits through “My Chart”, a national software program that collects all of patients’ medical histories.

Interestingly, TeleHealth, while not all that popular before COVID, is not likely to go away after. Physicians and patients seem to like the option to speak to physicians in certain circumstances. TeleHealth is NOT a good substitute, though, when it would be best for treating physicians to actually examine patients.

I would offer a word of caution with TeleHealth not to attempt to transition ALL care using this technology. The process is similar to “concierge medicine”, which I do not recommend. The patient notes generated by TeleHealth are also discoverable in a court of law, and due to the informality of the visit, conversations may be videotaped and preserved. You should ask your doctor whether the TeleHealth meeting is videotaped and saved.

Still, TeleHealth doctor’s visits are likely to continue into the future after COVID since physicians can bill the same rates and they are Medicare supported.

Why is there so much confusion at my insurance company? My claim is a mess.

In answering this question I’m going to ask you to think beyond your own claim for a moment. Consider that those workers who legitimately come down with COVID have filed for disability. And….there are those whose employers have gone out of business who have also filed. The influx of new claims must be astounding.

Insurance companies are, of course, denying claims because employees or business owners lost their jobs. You have to actually be sick with COVID before filing disability claims. I have been told that many, many people have filed disability claims for exposure to COVID, or the existence of pre-existing medical conditions that makes them more susceptible to the virus, and therefore unable to work.

Remember disability definitions tie together medical impairment that precludes someone from working, so I can imagine what the burden is at the insurance company, for example, that would prompt Unum to ask that people not apply when they have COVID.

The absolute important thing to remember about disability claims and COVID is that nothing about the internal processes will return to normal. It’s hard these days to actually say that most insurance companies have “a campus”, or a central fixed point of management.

All internal processes have been outsourced remotely, from requesting records, reviewing patient notes, claims handling, chasing SSDI, and appeals. Due to some of the language problems I’ve encountered, it’s also fair to say that “remote” may also mean “offshore.” Nothing will go back to what you are used to because outsourcing and hiring remotely are CHEAPER than covering the fixed costs of a facility and overhead.

Beware of short deadlines.

Remote paper chasers such as Release Point, EMIS, PMIS etc. often do not know the content of Plans/policies well enough to know that these contract documents allow certain time frames in order to provide continued “proof of claim.” What appears to be happening is that these third-party paper chasers are giving “10-day” notifications to physicians in order to submit patient notes and forms.

Besides being totally ridiculous, short deadlines are violations of the Plan and policy and need to be challenged. Every claim with short deadlines I’ve challenged have been reversed to policy provisions every time. Insurance companies know they can’t defend “short deadlines” that are out of Plan or policy.