How to manage an error in the medical records

Posted by Jack Cotlar, M.D. on Wed, Jan 04, 2012 @ 06:50 AM

dreamstimefree 164477 resized 600Problem: You or your underwriting adviser discovers an error in the medical records that will probably adversely impact the carrier’s underwriting assessment (rating). What might you do, prior to case submission or after the carrier informs you there is a problem? Example: The records state that your client has a permanent pacemaker and you do not think he or she does.

Example solution:

1. Verify with your client whether or not he or she currently has a pacemaker. If not, then ...

2. Find the page in the medical records that makes the statement that there is a permanent pacemaker in place.

3. Circle the statement that you believe is in error or ambiguous.

4. Have your client provide his physician a copy of this page (#3 above) along with a cover letter that addresses this issue.

5. If there is an error or a significant ambiguous statement in the medical record then your client can discuss with his or her physician the appropriate way to correct it or to clarify it.

6. Obtain a copy of the “corrected” statement and provide it to your carrier when the case is submitted.

In my opinion, explaining a potential underwriting issue and working with the client in order to solve the problem pays dividends, especially if problems are solved before the case is initially submitted. Addressing medical underwriting problems in this fashion may not only resolve the underwriting problem, but the client will appreciate your expertise that separates you from others. To see similar case examples, GO?HERE.

Topics: Dr. Cotlar, Life insurance medical underwriting, Strategic Medical Consulting, medical undewriting, medical records, Errors in medical records

A Proactive Way to Avoid a Possible Medical Underwriting Glitch

Posted by Jack Cotlar, M.D. on Mon, Sep 05, 2011 @ 10:19 AM

dreamstimefree 168394 resized 600Question: You have a client who is applying for a large amount of life insurance coverage and he sees a therapist for anxiety. The “APS” or attending physician’s statement you receive from the therapist is a one-page document that cites a diagnostic code for “anxiety” or only a diagnosis and no other useful descriptive information. You are concerned that the carrier’s underwriter will want more information given the size of the case, and you cannot afford a time delay. How would you manage this situation?

The most simple and direct way is to go to the client explaining the underwriting dilemma and to do so before the case is submitted. Providing the carrier up front what he or she will need to do their work properly is likely to greatly expedite the case being issued. There will be occasions when providing answers to key questions in a cover letter will allow the underwriter to make a decision about this issue without needing another APS. To see a brief case example, go HERE.

Topics: attending physician statement, underwriting glitch, underwriting dilemma, Dr. Cotlar, Life insurance medical underwriting, medical underwriting, Strategic Medical Consulting, medical records