Handling Claims - Medical Records

[Birdman300]

Sold a FE policy to a husband and wife last year about this time. He died just before Christmas last year. I helped them file the claim right away (crossing my fingers). I call Lafayette every 2 weeks to follow up and the tell me the same thing...they're waiting on medical records from some hospital.

This might be a dumb question...but do you veterans have any special tricks to get the medical centers to release records faster?

I thought about drafting a letter signed by my client that gets sent directly to the medical centers to try to get them to put some urgency into turning over records, but I doubt it will make a difference. Any ideas?

 

[smokin goose]

I'm not a veteran, but I'll just throw this out there. Call the hospital everyday. If they tell you to stop calling, call them twice a day.

 

[rousemark]

I have had some success at some hospitals by taking a signed HIPPA for to the hospital and talking with the medical records supervisor. Word of caution, some insurance companies will not accept medical records mailed to them by the agent.

 

[Birdman300]

I'm not a veteran, but I'll just throw this out there. Call the hospital everyday. If they tell you to stop calling, call them twice a day.

Yeah, I actually did that...not twice a day or anything like that but I did call...what they told me was "they are only allowed to talk to the patient, not me". The people that work in these records departments don't give a crap about anyone other than the person signing their paycheck. The office I tried calling told me that they don't have any staff that handles it. Supposedly they have a 3rd party contractor that comes in once a month to handle looking up and copying records. I've never heard that before. The only person that would make any difference in calling the medical records office would be the insured (who's dead) or beneficiary (who has no relationship with that hospital). The deceased is the customer for the hospital...not the agent or insurance company. They don't give a crap about me or some mutual.

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I have had some success at some hospitals by taking a signed HIPPA for to the hospital and talking with the medical records supervisor. Word of caution, some insurance companies will not accept medical records mailed to them by the agent.

I can understand why they wouldn't. If I were them I wouldn't accept it from an agent either. Incidentally, which ones don't allow it?

 

[rousemark]

Yeah, I actually did that...not twice a day or anything like that but I did call...what they told me was "they are only allowed to talk to the patient, not me". The people that work in these records departments don't give a crap about anyone other than the person signing their paycheck. The office I tried calling told me that they don't have any staff that handles it. Supposedly they have a 3rd party contractor that comes in once a month to handle looking up and copying records. I've never heard that before. The only person that would make any difference in calling the medical records office would be the insured (who's dead) or beneficiary (who has no relationship with that hospital). The deceased is the customer for the hospital...not the agent or insurance company. They don't give a crap about me or some mutual.

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I can understand why they wouldn't. If I were them I wouldn't accept it from an agent either. Incidentally, which ones don't allow it?

I don't know but I had one that would not accept medical records for an application from me.. I believe that was UHL.

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AGLA/AIG would not accept them on a claim.. I had forgotten about that one.

 

[Cornelius]

Have the wife call the VA hospital social worker and ask for help or guidance.

 

[rousemark]

Have the wife call the VA hospital social worker and ask for help or guidance.

Didn't see he mentioned a VA hospital.. They can be a pain when it comes to records.. However, I took the reference to "veterans" was Insurance veterans and not military veterans.

 

[shonceman]

Sold a FE policy to a husband and wife last year about this time. He died just before Christmas last year. I helped them file the claim right away (crossing my fingers). I call Lafayette every 2 weeks to follow up and the tell me the same thing...they're waiting on medical records from some hospital. This might be a dumb question...but do you veterans have any special tricks to get the medical centers to release records faster? I thought about drafting a letter signed by my client that gets sent directly to the medical centers to try to get them to put some urgency into turning over records, but I doubt it will make a difference. Any ideas?

Move your calls to Lafayette up to weekly. Sometimes the company's claims office doesn't have a sense of urgency on contestable claims. Your more frequent calls to them may trigger them to more aggressively pursue the records from the provider.

 

[VolAgent]

Move your calls to Lafayette up to weekly. Sometimes the company's claims office doesn't have a sense of urgency on contestable claims. Your more frequent calls to them may trigger them to more aggressively pursue the records from the provider.

He would be harassing the wrong person then.

He needs to tell the beneficiary to start calling the hospital. She may not have a relationship with them, but they definitely don't want calls from her about how bills are going unpaid as she waits on the insurance payment because the hospital is dragging its feet about returning records.

Many companies outsource this to EMSI. Companies have sent me their records in the past when it really dragged out. EMSI was calling almost to the point of harassment to get the records. This is simply the records department. In the OP's case, it is that they have a 3rd party that comes in once a month. So, basically they are stuck waiting for the contractor's next visit.

 

[Birdman300]

He would be harassing the wrong person then.

He needs to tell the beneficiary to start calling the hospital. She may not have a relationship with them, but they definitely don't want calls from her about how bills are going unpaid as she waits on the insurance payment because the hospital is dragging its feet about returning records.

Many companies outsource this to EMSI. Companies have sent me their records in the past when it really dragged out. EMSI was calling almost to the point of harassment to get the records. This is simply the records department. In the OP's case, it is that they have a 3rd party that comes in once a month. So, basically they are stuck waiting for the contractor's next visit.

This is exactly right. I'm quickly learning that me calling them doesn't even register. Has to come from beneficiary. And yes the med facility is limited by how often the 3rd party comes in...once a month.