My insurer sent a letter to my current doc. They asked her for clinical note and test after Nov 2017. No request for any thing else. She wrote a details summary instead. Why would they request this and would it be acceptable for her to have just sent in a summary instead in letter form?
If the insurer accepted the information in the format the doctor provided, then it was acceptable.
The insurer probably asked for clinical notes and test results for a few reasons:
1 - The detailed notes and test results provide factual information. The insurer’s doctors and other medical professionals will review your file and draw their own conclusions and prognosis and then check back if they have questions.
2 - The cost to the insurer to request notes and test results is less than asking for a narrative report or a completed form. If the insurer asks the doctor directly for information, the insurer pays the doctor’s bill for the information/report. Your doctor will send a bill for copying the clinical notes and test results. If she chooses to write a report instead, this may be better for you, but since the insurer didn’t request a report and agree to pay the doctor for a report, they will probably not pay her bill for a report. The cost for her summary report will be at the medical association’s rate (much higher than photocopying the medical file). It makes sense to me that on a psychiatric case, for example, a report would make lots of sense as shorthand in clinical notes would not really paint much of a picture (not that I have any medical training!). Writing a narrative report and including notes and tests results can provide a comprehensive and fair picture on a patient. Of course, you really need a great doctor who cares a lot about you, as it takes a lot of time on their part to write a full report (and they don’t really get compensated for this work).
3 - Getting notes and test results is quick and doesn’t require any effort other than the doctor’s instruction to their assistant. Timely turnaround is important to an insurer and a claimant. Doctors can take forever to write letters and fill in forms since this kind of paperwork can sometimes take hours on complex cases.
Hope this helps.
Thank you so much this is very helpful. Never thought of the fact that it would be more expensive to ask for a report. My doc sent a letter of summary as she does not like to release notes. Hopefully they are ok with that.