Although I’ve written many articles over the years about doc-to-doc calls, one thing remains crystal clear today. Namely, that insureds and claimants are permitting their treating physicians to discuss R&Ls and other health concerns with insurance physicians on the phone. And, it isn’t good.
Most physicians today just want the problem of insurance phone calls to go away, and will provide information without thinking about their patients. Yes, there are small numbers of physicians who realize what insurance docs are trying to do, and refuse, but what I’m seeing today, is that MOST physicians are taking the calls and are throwing their patients under the preverbial bus.
Simply put, the current trend is that whenever Unum’s docs, for example, can get through to treating physicians, claims are denied shortly thereafter. You can take this information to the bank.
First, let’s deal with Unum’s intentional objectives with doc-to-doc calls.
- Intimidation. Unum’s physicians always present their credentials to the treating physician in an effort of using stature within the medical community to say, “my opinion is more persuasive than yours”, or, I’m more qualified than you are.
- Purpose. Unum’s purpose is to convince your treating physicians that its opinion that you can work is the most persuasive. Most treating physicians will give in to these types of strategies and agree.
- Design. Unum exaggerates and lies to the treating physician about internal reviews of medical records. This is done deliberately to intimidate your doctors. The purpose of doc-to-doc calls is to obtain the treating physician’s buy-in to return to work. Unum will allege a certain category of work capacity (sedentary, Light, Medium, Heavy) and many treating physicians agree.
- Stealth. Unum isn’t stupid. The phone conversation is presented to your physician as a search for information rather than back-up for a claim denial. So many physicians are pulled right in to this sort of thing. Unum usually sends out a fax afterward re-stating the basis of the phone conversation, much of which is untrue. Physicians are asked to change anything that’s wrong, but if they don’t it is presumed they agree with Unum’s assessment. In today’s busy patient office most physicians barely glance at the letters, and don’t respond at all. This gives Unum exactly what they want – a no challenge claim denial.
What is worse, are calls taken by RN office managers who think “they know” what your functional capacity is, and they give out inaccurate information without checking with the doctor, or the patient file. Work capacity levels provided by Nurse Office Managers should be considered false, but of course, if the opinions are in Unum’s favor, hey, why not.
Please do not get pulled in to doc-to-doc calls because 1) your doctor is not compelled to take the calls, and 2) you don’t have to give permission to your doctor to do them. Many physicians have already realized that phone calls are “electronic transmissions” and are subject to HIPAA. You and your doctor should always discuss what he/she is to do if phone calls from an insurance company are received. YOU DON’T HAVE TO GIVE YOUR PERMISSION TO YOUR DOCTOR TO TAKE SUCH CALLS.
Your doctor could respond that while he is willing to provide information in summary form (forms), his office does not take calls from third-party insurance companies. This way, your doc can fill out a form, which is reviewed by you before it is sent anywhere.
What I’m trying to explain here is that based on the information I have about 98% of disability claims are denied after a doc-to-doc call. The remaining 2% is a risk I don’t believe any insured will want to take when it is totally avoidable.
