Was That A Consideration, Option Or Order From Your Doctor?

If 60 Minutes was doing a segment on life insurance applications and how underwriters interpret your medical records they would have to focus on one of the biggest stumbling blocks, doctor’s recommendations for testing. To be fair, there wasn’t any life insurance underwriter present at your doctor appointment to hear the real tenor of the conversation and recommendation. The office notes might say something like, “discussed snoring – provided referral for sleep study”. Doctors don’t tape and have their conversations transcribed into the records of their patients, so that note from the records came from a longer discussion that might have gone like this….

1. The patient and his wife came in for a regular checkup and the wife took the opportunity to vent about the husband’s snoring. During the discussion the doctor noted that snoring is a problem that can be caused by a number of things from sleep position to upper and lower jaw alignment to allergies. In some cases it can be caused by sleep apnea. So the doctor sends the patient on his way with material on ways to determine and fix the majority of snoring problems and, if none of those seem to help, “here’s a recommendation (prescription) for a sleep study if you decide it’s necessary”.

2. The patient and his wife come in specifically to discuss a snoring issue that has become a real problem in the house. They discuss all of the possible reasons for the raucous night time chorus and the doctor tells them several things they can try, but says, “It might be worth getting a sleep study just as the quickest way to figure out what’s causing the snoring, so here’s a referral if you decide that’s a direction you want to go”.

3. The patient comes in complaining of feeling unrested and lethargic during the day. He says he’s been checking his blood pressure at Walmart and it’s been running kind of borderline by the chart they have. And he says his wife has complained that he frequently snores very loudly and almost seems like he’s gasping for air. The doctor explains all of the things that can cause the symptoms and notes that his blood pressure is a little higher than optimal, and then says, “I think you should get a sleep study. While it could be something else, the symptoms you’ve described make it worth being checked for sleep apnea. Here’s a referral to the sleep study clinic. Make sure they send a copy of the results to me.”

All of those scenarios could be summed up by “discussed snoring – provided referral for sleep study”. 1 and 2 make it an option or a consideration that the doctor is leaving up to the patient and 3 is telling the guy that he really needs to have this checked out. He’s telling the guy to get it done and have a copy sent to him. So, have you ever stopped your doctor and asked him how he’s going to write up your office notes? Do you ever look over your office notes and see if it seems right to you? Have you ever suggested to your doctor to be clear in his notes if it is an order or an option to use that referral he gave you?

And what do you do when a life insurance underwriter puts a screaming halt to your application because your records say “provided referral” for this or that test and you never did the test? The life insurance take on that is that you are non compliant with your doctor’s “orders”, when it could be as simple as you went home and your wife propped a pillow against your back to keep you on your left side, you quit snoring and therefore you never used the “option” of having a sleep study. Once it’s hit underwriting and your chances of life insurance are held in the balance you need to…..

1. Go back to the doctor and remind him of the conversation and ask him to write a memo stating that it was up to you whether you needed to pursue the testing and forward that to the life insurance company

2. Get a 2nd opinion that makes it clear that a sleep study isn’t necessary (if you’ve changed doctors thanks to Obamacare you may have to go this route) and send that to the life insurance company .

3. Get a sleep study and do whatever the test results recommend and let the life insurance company know.

Bottom line. A lot of doctors are good at health care, but very few are good at making sure their records and intentions are going to be clear to a life insurance underwriter. If you have questions or need help getting past a referral that was an option and not an order, call or email me directly. My name is Ed Hinerman. Let’s talk.