Insurance companies have resurrected using what I refer to as “third-party paper chasers. Please Point is just one of the companies who are hired to chase medical paperwork for disability claims. Clamify is another one. These companies have always harassed insureds and treating physicians, often making phone calls to their offices everyday, sometimes more than once. Physicians are getting sick of it and are trying to find alternatives as to what they should do.
First though, let me explain that these third party chasers have no authority over your claims. They are administrative personnel “who chase paperwork”. They make no decisions, and yet they are driving people crazy. They often use “Unum” letterhead (or another insurer) to make them look credible, but in the end, they harass and make calls to the point that normal medical records requests become much more difficult than they need be. From their perspective, I guess that’s the point.
If you are being harassed by any number of third-party paper chasers, notify the claims handler that you will provide the records yourself and to “cease and desist” from contacting your physicians. Always deal directly with your claims handler, never Release Point because you won’t get anywhere. One time when I contacted Release Point I was told,” this is our protocol and how we do things.”
Remember in prior posts that I informed you insurance companies were going back “to their old sneaky ways?” One of the ways they are doing this is to request medical “proof of claim” from periods way before you claimed disability. If there are pre-existing issues with your claim, insurers are entitled to go back three months prior to the Effective Date of your Plan or policy.
For IDI claims, if there is a Contestability issue, insurers could legitimately ask for paperwork before your Date of Disability. Beyond that, they have no reason, or right, to request patient notes way back in time. A good example, is Guardian requesting records back to 2018 for a date of disability in 2020. No pre-existing or Contestability issues. This is unreasonable nonsense, and you don’t have to honor those requests.
If you are receiving insured’s correspondence in the mail, please remember to date the envelope on the day you receive it. The 30-45 days begins as of the “day of receipt” and since insurers are sending out letters as much as two weeks after the date of the letter, you need to initial and date the envelope as to when the mail is actually received.
In keeping with this point you and your physicians have 30-45 days (ERISA) to provide requested “proof of claim”. We do not allow insurers to operate outside of the Plan or policy contract.
These are just a few of the questionable claims practices to watch out for. I’m sure there will be many others as insurers get their risk management together again.
