Insurance wish list?

Keith Ferguson

The July Practice Tips article1 on dealing with insurance company forms did not seem to have many tips, but was more a wish list from the life insurance industry. As Dr Empringham notes, most life insurers use third party service providers to collect underwriting information. He notes that insurers would find it useful for physicians to list the patients’ problems and provide supporting test results, but that, in most cases, documenting office visits is not necessary. However, this is not the way that the major service providers ask for the information. Their requests are usually for dates, histories, diagnoses, and treatments—seemingly the documentation of office visits that Dr Empringham says is unnecessary. Perhaps the insurance industry should address this with its service providers.

Dr Empringham also notes that it is important for insurers to receive patient information in a timely manner. The College of Physicians and Surgeons of Ontario defines “timely” as 60 days. Insurers seem to define it as “drop everything and do it now.” These requests are often labeled as “urgent” or “please rush.” My office receives calls and faxes asking about the status of reports within days of receipt of the requests. It seems that insurers have begun asking their clients to pressure physicians as well, as I have started to receive calls from patients asking about reports shortly after the requests have been received. If the insurance industry understands that “physicians’ time is at a premium,” as Dr Empringham says, this kind of behaviour doesn’t show it.

The other difficulty I have run into from these service providers is payment. They will often either send a substandard payment with the request for information or ignore the bill that is sent with the report.

My approach has been to develop a form letter that is faxed back to the service provider when the request for information is received. It acknowledges receipt of the request and advises the service provider of the fee. The service provider is advised that the information will be provided within 15 working days of receipt of payment and that there will be an additional charge for the time taken to respond to any status requests prior to that time. This has worked remarkably well in terms of payment—cheques that used to take months often arrive within a week. Unfortunately, it has not seemed to slow the status requests, but I can either ignore them or bill for the time spent responding.

Lately, as the number of “urgent” requests has increased, I have added a section to my form letter indicating that there is an additional charge for such requests, as it is difficult to budget time for them. The service provider can then decide if the urgent need for the information warrants the additional fee, and, if so, I am compensated for the inconvenience of trying to fit the request into my schedule.