The insurance company wants my medical report to make decision, but the specialist ask insurance company for specific authorization to release my report. Why insurance company didn’t ask me to sign an authorization form and send to the specialist? Instead, they keep saying it’s my responsibility to make sure they have the report to make decisions. They also ask me if my family doctor get the report and can send to them. I’m confused about their process and my role there. It also makes me nervous…
If the insurance company needs a report from a specialist or any tests then I get a copy from my GP and fax or email it to my case manager. It’s too much hassle for them to request every report from a GP or a specialist.
I sent a letter to my insurance company requesting that all report requests go directly to the doctor or medical professional as it was impeding my recovery and adding stress. It also saves them time as it eliminated me (the middle person)
You most likely signed a generic authorization when you applied for benefits through your insurer and they use the signed and dated form to request information and updates.
They are not there for you, the insurance company will do what they can to get what is required under the contract.
You do have responsibilities, so start reading about them. You have to provide reports from health care providers on a regular basis, until they stop requesting them. This will be when they have enough detail to know there is no way to challenge your case.
The insurance company is not your friend, they have an obligation to pay if the case is documented properly and you qualify.
Most insurance companies will Delay, Deny, Defend! Until you give up, or suffer mentally and financially. See the book, https://www.amazon.com/Delay-Deny-Defend-Insurance-Companies/dp/1591843154
My response was anytime my spouse’s Insurer asked for medical documents that they wanted him to obtain, was that we would then request updated copies of his claim record to be sent to us. A tit for tat approach, that reduced them from asking.