Originally, conversations between insurance and treating physicians wasn’t such a bad thing. However, the temptation to strategize outcomes in favor of insurers ruined what could have been a valuable “consensus-seeking” activity.
The goal of a doc-to-doc call today, is to give the insurance company an opportunity to do intimidate treating physicians into agreement with the insurance company’s agenda that insureds can return to work. I’d like for you to think about that for a moment.
Your physician is running a very busy patient-oriented practice and wants phone calls from insurers to just go away. Sometimes physicians speak with insurance docs on the phone before consulting files and often give inaccurate information. Let’s not underestimate companies like Unum and CIGNA which have been front runners to deceptive claims practices from the beginning. Companies such as these have streamlined the doc-to-doc process to a science.
Some treating physicians are not told of the calls from insurers because nurse managers “handle it” and really mess things up. When the doc tries to straighten it out with “this patient can’t really work”, it isn’t credible and insurers will not accept anything the doctor says from that time forward.
Growing concerns among physicians have caused a trend not to accept calls from insurance companies, but there is a minority of treating physicians who remain arrogant enough to take calls from insurers because “they can handle it.” Maybe, maybe not. I’ve seen more “botched” doc-to-doc calls than I care to mention.
The real damage caused by a doc-to-doc call is what happens afterward. The insurance company sends your treating physician a “confirmation fax” that invites your doctor not to respond at all if he/she agrees with what was said.
The actual description of “what was said” is NEVER accurate, therefore for a busy doctor who glances at the fax, or doesn’t read it, does more harm than any actual conversation could have. Treating physicians MUST respond to these confirmatory faxes, or risk throwing patients under the bus by not correcting what’s been misrepresented.
The information I’ve seen recently disturbs me because in those cases where Unum specifically got through to treating physicians, they threw the patients under the train with approvals for return to work. No physician should be willing to provide any insurance company with patient medical information anyway since phone calls are considered “electronic transmissions” and could be seen as HIPAA violations.
All insureds should have conversations with their treating physicians about what they should do when calls are received from insurance doctors. Write on your doctor’s HIPAA release that you do not give him/her permission to speak with any insurance doctor on the phone. Make it official.
What is important is for insureds to realize that the “intent” of a doc-to-doc call isn’t in their favor and requires the attention of both the insured AND his/her physician to manage.
Don’t allow the insurance physicians to exert their influence over your treating physicians in order to put forth the agenda of denying more claims.