Sometimes insurers must spend a little more to get best outcome

No matter what type of insurance line is involved, medical care will often be the largest part of the claim. The associated care and treatment will be the primary driver of damages.

So how do you get a handle on the medical aspects of a claim and the associated charges so that an optimal outcome is achieved?

Here are some tips:

Be proactive: Don’t wait. Work the claim aggressively. Open medical cases take on a life of their own and can quickly spiral out of control. Review all material as soon as you get it.  A single diagnosis code can be a big tip.

Use all internal and external resources: Pull out the stops and USE resources – internal and external. Medical review software can help. Medical professionals are just an email away. At MKC Medical Management, we often get questions by phone and email on basic things.

Don’t be penny–wise and pound foolish: Sure, medical reviews through experts or software  can sometimes be expensive, but, in the long run, they will pay off. Take advantage of the resources. For smaller claims, more basic reviews are always a great place to start.

Look at the fundamentals of the case: Really focus on the foundation of the mechanics of the injury. Ask for initial vehicle AND bodily impact points and verify initial complaints against the medical visit, records and police report, if available.

Set the reserve early: Early assessment and analysis is key to setting the initial reserve. Do frequent re-assessments against new medical records. If you’re not sure what the records indicate, consult an outside medical provider for additional insight and prognostications.

Don’t jump the gun on settlements: Depending on the diagnoses, it may not be advisable.  Conditions such as burns and head trauma often improve with time. In fact, for many conditions, maximum medical improvement, the point when a patient’s condition is stabilized, is not until two years after an injury.

Evaluate, review and consider ALL co-morbidities: Diabetes, hypertension, osteopenia, peripheral vascular disease and many psychiatric conditions can have an influence on the injury sustained. If you don’t know the impact, ask a medical professional.     

Look at the medical case as a whole: Don’t just review the narrative or bills on their own. Review the documentation side by side. Are critical pieces of information missing?

Seek an outside film review: This may sound expensive, but, when possible, have a physician review the actual films, especially if you don’t have the written diagnostic report.

Anticipate higher emergency department care: The cost for all emergency department care is going up and becoming more costly every year. Review ALL emergency department documentation carefully. Seek help with an expert in deciphering the records.

Upfront, thorough medical reviews can be costly and time consuming. But, in the end, they can result in the best outcomes for both patient and insurer.