Does your physician just scribble short answers on your medical update forms? Do you let that form stand and just send it in anyway? Unfortunately, that’s not going to work as well for you as it could. When insurance companies are back to “stacking the deck”, as they now are, , a well-completed medical form is just what’s needed.
I’ve been a Consultant for a long time now, and I can tell you that in the “aggressive” insurance environment we now live in, a short, one work answer medical form isn’t going to cut it.
What does surprise me is that insureds seem OK with it, and actually feel glad that they were able to get a filled out form at all. Let me go over what these update forms need to document and then you can compare your doctor’s form with these requirements.
- The form must clearly state what your Primary and Secondary Diagnoses are complete with ICD-10 Codes. Second, the form should always contain the following information.
- Restrictions and Limitations and why you are unable to work. Many of the forms I’m reviewing today do NOT contain R&Ls. For explanation, “Restrictions” are work activities you may NEVER DO and “Limitations” are work duties you may do, but only to a limited extent. “This patient is restricted from attempting any work in which she is likely to be unsuccessful.”
- If you are “totally and permanently disabled”, then your doctor needs to say so, “Based on this patient’s long-term medical history, treatment ad consultation, he/she is determined to be totally and permanently disabled.”
- Prognosis: Prognosis should be indicated somewhere on the form.
- Treatment Plan, should be specifically defined, and more than just a few words. “This patient is recommended to cease all work activity while engaged in medication management, physical therapy, consultation and further treatment.” This is a short example, but whatever pertains to you, it should be clearly defined.
- A statement about daily activity and the inability to perform Activities of Daily Living should be included. “This patient is recommended to remain physically active as able with moderate levels of exercise, such as walking.”
- A statement that the current clinical consultations and treatment is “appropriate and regular care.”
- A statement that patient notes will be provided with appropriate authorization, but that the office will not communicate health issues by phone.
As an aside, please take a look at the last form completed by your physician and see if it includes these criteria. If it doesn’t, then Release Point, Clamify, or your Claims Handler will keep “bugging” your physician for more information, and your doctor is no longer a happy camper.
I’ve been trying for years to convince treating physicians to “invoice” insurers when they contact physicians directly. Listen carefully here…..If a request for medical records is sent to the insured, then it is the insured’s responsibility to provide the information. But, when the doctor is contacted directly by the insurer for patient notes, he/she can bill the insurer for reasonable costs and only release the records when payment is received. Unfortunately, insureds PANIC and ask that the information be sent anyway, even when it is a poorly completed update form. Or worse, the doctor faxes the information directly to the insurer leaving the patient guessing as to what was reported.
Most readers are probably thinking, “My doctor does whatever he’s going to do, how can I change that? I’m just glad he fills it out at all!” While this might be somewhat true, a badly completed medical form isn’t helping you maintain benefits.
I am surprised sometimes how little patients actually discuss anything with their physicians, including the requirements of disability reporting. About half of treating physicians today use types of “medical software” that DOES NOT INCLUDE INPUT FIELDS FOR medical R&Ls. Even the patient notes are devoid of this information.
Disability reporting is unique and different from any other reporting. It is the patient’s responsibility to discuss reporting criteria with their physicians. Some people actually tell me, though, they are afraid to talk about it with their physicians. Today, physicians are operating under the “15 minutes office call” rule, and won’t take the time for do a form right even if you asked them to. Unfortunately, physicians just give the form to their nurses and ask them to fill it out. That’s not good at all!
Please be aware of the criteria I’ve mentioned above the next time you read a completed form by your doctor, and mentally do a checklist. What is written on the form, is up to you, and whether or not your doctor has a good understanding of what needs to be on the form for disability purposes. What I’m saying is that you should no longer send in mediocre forms and expect to keep receiving your benefits. It’s not going to happen in the “unfair claims evaluation mode” we’re now in.
