Holding For Follow-Up

    There is nothing much worse than finding out that a completed application is suddenly incomplete—especially when a medical factor is holding things up. Attending physician’s statements, lab tests, hospital notes and the like are hard enough to get in the first place, and that much more difficult when both client and doctor feel they have provided everything needed. In these cases, it’s best to immediately find out what caused the hold up and the easiest ways to proceed quickly and painlessly.

    Follow-up of a medical condition or abnormal finding is helpful but not always necessary. For instance, notes may be missing from the past which are well-addressed by a subsequent visit or further testing. The 2008 abnormality or APS visit may not be needed if one from 2010 brings everything up to speed.

    Likewise, the doubts of an underwriter from one physician’s note may be adequately explained by a specialist’s or consultant’s note. If the past result really isn’t going to influence underwriting in the present, that requirement can be waived and additional sources can be relied upon.

    Much of whether follow-ups are necessary depends on the underlying condition. In cancer cases—especially when the cancer is relatively recent—a follow-up note or test that shows the applicant remains cancer free is of course essential. Likewise in heart disease, an underwriter may want to see that a client is following through on care and that long term compliance translates to long term survival. However, when the disease is more chronic, waiting for a subsequent note or test to show “status quo” probably won’t influence an offer; a recent “good health” visit may be all that’s required.

    Recommendations for specialists can often be dicey in evaluating whether a case should be held until follow-up is obtained.

    Radiologists are particular sources of delay—many times due to the way they are trained to communicate their findings. Radiologists usually don’t have the luxury of either knowing the background of a case or meeting and examining the insured. Their only contact may be with the films they receive and a terse one-line request for the procedure. As such, they will cover their bases by trying to include or exclude even minute possibilities and ask for follow-up films to see progress of what they are looking at.

    A quick note from a primary care doctor who knows the patient may reassure an underwriter that follow-up isn’t truly required. Likewise, the longer the interval recommended to follow-up, the more likely the finding in question is benign. Most doctors or radiologists won’t let a patient go six months between exams if they are truly suspicious of an active disease process and, as such, there isn’t the need to wait that period of time before making an offer on a case.

    Sometimes determining when a follow-up visit is necessary, as opposed to precautionary, can be a very sticky subject in terms of reassuring an underwriter that the primary reason for the consultation wasn’t a potentially mortal one. Doctors are all trained in this “never can be too sure” world to warn patients of most any possible end result of their complaint—sometimes the reason is to make sure the patient doesn’t ignore serious changes and other times more an attempt to legally cover any potential liability. Either way, an explanation by the insured or the health care provider can go a long way in breaking open the log-jam.

    Basically, then, a “holding for follow-up” doesn’t always have to be like sailing into the Bermuda Triangle.
    •  First, ask the underwriter for exactly what he needs. The solution may be as simple as a statement from the insured or a small note from the doctor addressing the specific curiosity.
    •  Ask if a subsequent visit or appointment with another physician would adequately answer the question.
    •  See if an “as is” offer is available without the information—sometimes that is satisfactory to issue a policy and a request can be made later on for a reduction in rating class if subsequent information is favorable.
    •  Remember to stress to the health care provider the importance and simplicity of getting a short, directed note that answers the small question being asked, not another lengthy narrative or summary of all the patient encounters.

    If all else fails, find out exactly what is needed—no more, no less—and try to get it. It certainly beats the alternative!

    MD, FACE, FLMI, board certified internist and endocrinologist, is medical director for SBLI of Massachusetts. He has extensive brokerage and life insurance experience over 30 years with Pacific Life, MetLife Brokerage and Transamerica Occidental Life.

    Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World from 1991 to September, 2021.

    Goldstone can be reached by ­telephone at 949-943-2310. Emaill: drbobgoldstone@yahoo.com.