Re: Re: Progressive adjuster bullying patient

[Guest guest]

And I generally agree with Dr. Freedland as well.

Imagine that !! :-)

G.

Gatti, Gatti, Maier, Sayer, Thayer, & Associates

1781 Liberty St. SE

Salem, OR 97302

1-

msmith@...

From: oregondcs [mailto:oregondcs ] On Behalf Of TFreedland@...Sent: Thursday, May 17, 2012 10:11 AMTo: lauren_mccabe@...; oregondcs Subject: Re: Progressive adjuster bullying patient

Dr. McCabe -

As one who reviews of such cases, I can tell you when some aspect of the patient's history is withheld it raises suspicion. Statements like "Past history is non-contributory" actually suggest there is more information than what is not contained in the records.

Past history may be a factor, or it may not; until it is known a decision as to its significance is not possible. If the policy calls for providing certain information, the claim could be denied if information is withheld.

I, too, have had patients with sensitive components to their past history. It could be HIV, erectile dysfunction, poor body habitus secondary to obesity, and number of other conditions that the patient perceives as personal. It may become apparent when the condition is explained. There may be a concern by the insurance carrier that the condition or its treatment may complicate the patient's recovery. Side effects of many of the statin drugs include musculoskeletal complaints, as is the case with Accutane for teens with acne; these are possible examples.

That said, you, as the doctor, wish to maintain a level of trust, but at the same time be able to treat the patient for the compensible injury.

When I write the history in such as case I try to provide as much information as possible without breaching the trust with the patient. It might read:

Patient reports that she has not previously suffered any injuries beyond a sprained ankle in her youth. She is being medically managed for a condition that does not appear to effect the musculoskeletal system or any areas injured in the collision of May 16, 2012. She reports no other serious illnesses. There have been no hospitalizations (if there has not been any) or surgeries (again, if there have not been any). I am providing you with a copy of her records of prior treatment at this office. Per the patient's request I have redacted information about her medically managed condition. If you require further clarification, please have one of your consulting doctors contact my office.

If your response to an inquiry is hostile or resistive, it may appear as if you are hiding something. That only serves to heighten the perceived problem.

I hope this helps.

Tom Freedland, DC

Posted by: "lauren_mccabe" lauren_mccabe@... lauren_mccabe

Wed May 16, 2012 5:35 pm (PDT)

I have a patient who was injured in an MVA. Her vehicle and the other vehicle are both insured by Progressive, who in my previous experience has been a very difficult company to work with.My patient signed the records release restricting the adjuster's access to medical records that pertain to her MVA. Her adjuster is saying that unless she gets access to all prior records from my clinic that she has to deny the claim because the patient is not cooperating with the adjuster's demand and is therefore in violation of her auto policy. My patient suffered a whiplash injury and has never experienced an injury to her neck prior to this accident so any prior records would be to different regions anyway. My patient also has some sensitive personal history that she doesn't want to reveal to just anyone which is part of the sticking point.The adjuster has now called my office to inform us that they will have to deny the claim from this point forward due to the patient being uncooperative with their demands to see all their medical records.Any advice on how to handle this? My patient has already been referred over to Gatti et al.Sincerely, McCabe, DC, DACBSP

[Guest guest]

…I do as well…scary…isn’t it ha!! Vern Saboe, DC., FACO From: oregondcs [mailto:oregondcs ] On Behalf Of Sent: Thursday, May 17, 2012 10:15 AMTo: TFreedland@...; lauren_mccabe@...; oregondcs Subject: RE: Re: Progressive adjuster bullying patient And I generally agree with Dr. Freedland as well. Imagine that !! :-) G. Gatti, Gatti, Maier, Sayer, Thayer, & Associates1781 Liberty St. SESalem, OR 973021- msmith@... From: oregondcs [mailto:oregondcs ] On Behalf Of TFreedland@...Sent: Thursday, May 17, 2012 10:11 AMTo: lauren_mccabe@...; oregondcs Subject: Re: Progressive adjuster bullying patient Dr. McCabe - As one who reviews of such cases, I can tell you when some aspect of the patient's history is withheld it raises suspicion. Statements like " Past history is non-contributory " actually suggest there is more information than what is not contained in the records. Past history may be a factor, or it may not; until it is known a decision as to its significance is not possible. If the policy calls for providing certain information, the claim could be denied if information is withheld. I, too, have had patients with sensitive components to their past history. It could be HIV, erectile dysfunction, poor body habitus secondary to obesity, and number of other conditions that the patient perceives as personal. It may become apparent when the condition is explained. There may be a concern by the insurance carrier that the condition or its treatment may complicate the patient's recovery. Side effects of many of the statin drugs include musculoskeletal complaints, as is the case with Accutane for teens with acne; these are possible examples. That said, you, as the doctor, wish to maintain a level of trust, but at the same time be able to treat the patient for the compensible injury. When I write the history in such as case I try to provide as much information as possible without breaching the trust with the patient. It might read: Patient reports that she has not previously suffered any injuries beyond a sprained ankle in her youth. She is being medically managed for a condition that does not appear to effect the musculoskeletal system or any areas injured in the collision of May 16, 2012. She reports no other serious illnesses. There have been no hospitalizations (if there has not been any) or surgeries (again, if there have not been any). I am providing you with a copy of her records of prior treatment at this office. Per the patient's request I have redacted information about her medically managed condition. If you require further clarification, please have one of your consulting doctors contact my office. If your response to an inquiry is hostile or resistive, it may appear as if you are hiding something. That only serves to heighten the perceived problem. I hope this helps. Tom Freedland, DC Posted by: " lauren_mccabe " lauren_mccabe@... lauren_mccabe Wed May 16, 2012 5:35 pm (PDT) I have a patient who was injured in an MVA. Her vehicle and the other vehicle are both insured by Progressive, who in my previous experience has been a very difficult company to work with.My patient signed the records release restricting the adjuster's access to medical records that pertain to her MVA. Her adjuster is saying that unless she gets access to all prior records from my clinic that she has to deny the claim because the patient is not cooperating with the adjuster's demand and is therefore in violation of her auto policy. My patient suffered a whiplash injury and has never experienced an injury to her neck prior to this accident so any prior records would be to different regions anyway. My patient also has some sensitive personal history that she doesn't want to reveal to just anyone which is part of the sticking point.The adjuster has now called my office to inform us that they will have to deny the claim from this point forward due to the patient being uncooperative with their demands to see all their medical records.Any advice on how to handle this? My patient has already been referred over to Gatti et al.Sincerely, McCabe, DC, DACBSP

[Guest guest]

Dr. McCabe,

Dr. Freedland's advice is excellent. See if there's a way you can word the redacted file (with the patient's permission) and explain to the patient why an ins company might question or have a right to question past history. Perhaps a more detailed letter with no hint of hostility or irritation on your part or the patient's may change an adjustor's response. I don't know, maybe it's too late to repair this one, but it may still work

Thanks Dr. Freedland for a great description of communication. This is the kind of thing I hope we can do with the OCA. Have seminars for members and non-members as well as laison to insurance companies to help reduce adversarial communications. I realize it may not fix all the problems, but it may go a ways to help.

Minga Guerrero DC

abowoman@...

Re: Progressive adjuster bullying patient

Dr. McCabe -

As one who reviews of such cases, I can tell you when some aspect of the patient's history is withheld it raises suspicion. Statements like "Past history is non-contributory" actually suggest there is more information than what is not contained in the records.

Past history may be a factor, or it may not; until it is known a decision as to its significance is not possible. If the policy calls for providing certain information, the claim could be denied if information is withheld.

I, too, have had patients with sensitive components to their past history. It could be HIV, erectile dysfunction, poor body habitus secondary to obesity, and number of other conditions that the patient perceives as personal. It may become apparent when the condition is explained. There may be a concern by the insurance carrier that the condition or its treatment may complicate the patient's recovery. Side effects of many of the statin drugs include musculoskeletal complaints, as is the case with Accutane for teens with acne; these are possible examples.

That said, you, as the doctor, wish to maintain a level of trust, but at the same time be able to treat the patient for the compensible injury.

When I write the history in such as case I try to provide as much information as possible without breaching the trust with the patient. It might read:

Patient reports that she has not previously suffered any injuries beyond a sprained ankle in her youth. She is being medically managed for a condition that does not appear to effect the musculoskeletal system or any areas injured in the collision of May 16, 2012. She reports no other serious illnesses. There have been no hospitalizations (if there has not been any) or surgeries (again, if there have not been any). I am providing you with a copy of her records of prior treatment at this office. Per the patient's request I have redacted information about her medically managed condition. If you require further clarification, please have one of your consulting doctors contact my office.

If your response to an inquiry is hostile or resistive, it may appear as if you are hiding something. That only serves to heighten the perceived problem.

I hope this helps.

Tom Freedland, DC

Posted by: "lauren_mccabe" lauren_mccabe@... lauren_mccabe

Wed May 16, 2012 5:35 pm (PDT)

I have a patient who was injured in an MVA. Her vehicle and the other vehicle are both insured by Progressive, who in my previous experience has been a very difficult company to work with.

My patient signed the records release restricting the adjuster's access to medical records that pertain to her MVA. Her adjuster is saying that unless she gets access to all prior records from my clinic that she has to deny the claim because the patient is not cooperating with the adjuster's demand and is therefore in violation of her auto policy.

My patient suffered a whiplash injury and has never experienced an injury to her neck prior to this accident so any prior records would be to different regions anyway. My patient also has some sensitive personal history that she doesn't want to reveal to just anyone which is part of the sticking point.

The adjuster has now called my office to inform us that they will have to deny the claim from this point forward due to the patient being uncooperative with their demands to see all their medical records.

Any advice on how to handle this? My patient has already been referred over to Gatti et al.

Sincerely,

McCabe, DC, DACBSP