One of the major claim management errors insureds make is NOT realizing, “the process isn’t YOUR show.” In other words, insureds and claimants do not call the shots, nor can they tell an insurance company what to do. Oftentimes, this is quite humbling to some insureds who think they are the boss. Ranting, insisting and contacting the claims handler over and over again is not going to get your next benefit check released.
While we can’t control what an insurance company does, we clearly can control what WE do. And, there are claims strategies DCS Clients use that achieve the goals and objectives that benefit them. But, I see it all the time – those who think the insurance company has to do what they say, and are quite surprised when they don’t. Instead of trying to constantly “defend” a claim, think of credible ways to “promote” the claim, and come across as the “good guy.” The narcissists have to take a back seat on this one, and change their tactics in order to have paid benefits long-term.
Third-party paper chasers are eternal thorns in the backsides of most insureds. Not only are they aggressive to the point of harassing, treating physicians are screaming out for help to keep them from calling every day. Here are some things to remember about the “paper-chasers”.
- Companies such as Release Point, Claimify, MONY etc. have no authority over the decision-making of claims. They do only one thing –chase paper, namely patient records.
- Paper-chasers have a scheduled process that THEY WILL NOT CHANGE. Therefore, it does no good for insureds to contact the chasers looking for relief, understanding or approved delays.
- Always deal with your claims handler NOT a paper-chaser. If your physician is being harassed, send a fax to the claims handler saying something like, “please inform Release Point (example) to cease and desist from contacting my physician. You could even withdraw your Authorization, but I would only do that in extreme situations. You have the right to provide any requested records yourself, and I’d do that.
- Don’t be fooled. Paper chasers often send requests on the letterhead of your insurer to make your doctor thinks it is coming from an insurance company. Just always deal with the claims handler.
Most of the written letters you receive are “canned templates” chosen from a Window drop down. The Claims Handler is supposed to “edit” the wording to fit your particular claim, but they often don’t have time to do so. Therefore, don’t be surprised if you find a lot of gibberish in long letters that don’t even pertain to you.
A good example is the Independent Medical Evaluation notification paragraph that is appearing in most Unum letters. The Multi-State Settlement requires the notification, and so there is a “template” for it. Some Unum claims handlers add it to their letters, others do not, but in most instances it seems out of topic for most people’s letters. While employed, I did not like the fact that I was forced to sign my name to letters I didn’t write.
