Page 25 - CNF April 2021

Successfully Navigating
When It Comes T o
the Disability Claims Process
Patient Care – Be a Duck

BY VANESSA ORR out that include informa-
Ever think about a duck gliding smoothly tion on practice duties and
across the top of the water? The duck moves When it comes to disabil- a health history, and it’s
effortlessly. The water of the pond, lake or canal ity insurance, many physi- important that the infor-
barely ripples and behind the bird, there is typ- cians either choose not to mation on these forms
ically a small v-shaped wake which emulates have it or don’t have match.
continuously as the duck meanders to its desti- enough. This is mainly “The majority of delays
nation. That is what we see. What we do not see because they don’t believe are caused by conflicting
is what is going on under the water. Legs pad- they’ll ever need it—or information on those two
dling furiously. The webs on the bottom of the because they believe that if communications,” said
feet pushing the water with even, powerful they do have a disability Caldwell. “That raises red
strokes. Despite the chaos going on just below claim, the carrier won’t pay. flags with the claims exam-
the surface, you would never know it by simple “Often the only time that Wes Caldwell iner.”
observation. So, here is the question, when it BY JAY JUFFRE physicians hear about dis- Caldwell recommends
comes to your organization and how your staff ability insurance is when that physicians also contact
engages, what do your patients see? No matter how stressful, busy, or pre- the comments are negative; when people their insurers’ claims departments to find
occupied your team may be, does the patient see a calm, collected and pro- have a problem,” explained Wes out who will be handling their cases.
fessional group? Or can they feel the tension and hectic nature of whatever Caldwell, disability and benefits special- “These people are not there to deny
is going on in that moment. A big part of patient experience and their per- ist at Danna-Gracey, the largest inde- claims; they are just working with the
ceptions is subjective. When people seek any kind of medical attention, pendent medical malpractice insurance information coming to them, not know-
they want to feel as relaxed as possible and they want the medical staff agency in Florida. “If someone gets paid, ing your specific situation,” he
they are dealing with to convey a reassuring calmness. It is always impres- they rarely hear about it. The fact is, explained. “Opening up this line of com-
sive to see a doctor, nurse, or anyone on the medical team, despite some most disability carriers pay claims in a munication makes it easier to resolve an
adverse circumstances, put patients and their families at ease with their timely manner for legitimate claims—if issue if there’s a dispute.”
demeanor and actions. All too often, it is exactly the opposite. The team they didn’t, they wouldn’t be in busi- Caldwell adds that it’s important to
wears the mornings rush of activities on their sleeves or lets the stress of ness.” remember that a legitimate claim is an
one situation with one patient negatively impact the next ten. Create a When there’s a problem, it’s often illness or injury that limits or eliminates
culture where everyone from the receptionist to your most specialized sur- because of physicians’ lack of familiarity a physician’s capacity to practice, as
geon gets the importance of staying cool under pressure. Create an envi- with these types of claims, and a lack of determined by their doctor. “The prob-
ronment in which the patient, their families, and visitors have no idea resources to help. lem with some physicians, especially
what may or may not be going on behind the curtain. When it comes to “Unlike a lot of other insurance types, those with bigger insurance policies, is
patient care, simply train your team to resemble their favorite waterfowl there isn’t really anywhere to turn to get they consider using these policies as
and simply be a duck. information,” said Caldwell, who coun- retirement plans, which is exactly what
sels clients about the most common mis- carriers are looking for,” he said. “These
Jay Juffre is Executive Vice President, ImageFIRST. For more information on takes that physicians make when filling policies are not to be used as a way out
ImageFIRST, call 1-800-932-7472 or visit www.imagefirst.com. out the forms. just because you don’t want to practice
One of the biggest obstacles to claim anymore and your back hurts.”
approval, he says, is a lack of communi-
cation between the insured physician What If Your Claim is Denied?
and his or her treating physician, who All claims contracts have an appeals
determines if the disability affects the process, and some have more than one.
claimant’s ability to practice. “My advice to clients is to follow the
“You have to make sure that you’re process; if your insurer says to send a let-
both on the same page; you need to tell ter with further information, follow
your treating physician what you are those guidelines,” said Caldwell. “The
going to communicate to the insurance majority of claims that have been denied
carrier,” Caldwell explained. “Physicians will be resolved through that process.”
write a lot of things in their notes, so it’s If a claim is denied on the first level,
important to be aware of what they’ve Caldwell advises clients to go to the sec-
written.” ond level. If the claim is still denied, it
While carriers do have the ability to may be worth bringing in an attorney.
bring in independent physicians to verify “One of the biggest mistakes that
a disability, it is initially the treating physicians make is to hire an attorney
physician who determines a claimant’s right off the bat; it’s the last thing you
ability to work. want to do,” said Caldwell. “It puts
another layer of communication between
Filing a Claim the insured and the claims examiner, and
Generally, most carriers require physi- takes the insured completely out of the
cians to notify them of a claim within 30 conversation.
days of a disability, and most policies “If all of the appeals are denied, then
have a 90- or 180-day waiting period they may want to consider bringing an
before benefits can be received. attorney in, but even then, the physician
“Physicians sometimes confuse the should try to settle the case on his or her
two, and wait 180 days to file a claim, own,” he added. “There’s no harm in ask-
which is a mistake,” said Caldwell. “If ing the carrier if they will settle; if they’re
you have a condition that is hindering successful, it could save them a 30-40
your ability to practice—not like the flu, percent attorney fee.”
but something that may last three to six
months or longer—file the claim within For more information, contact Wes
30 days; you have nothing to lose.” Caldwell at wes@dannagracey.com,
Both the claimant and his or her treat- (888) 284-4198 or visit
ing physician will receive forms to fill www.dannagracey.com.

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8 April 2021 southfloridahospitalnews.com South Florida Hospital News