In the past week, I have had a few issues come up with authorization letters and faxes to medical providers. The language we use matters greatly.
I know many times we use the phone to provide the initial authorization, but you should always follow up in writing, email is even fine.
To the provider:
- Be clear in what body parts you are authorizing. Don’t just say back or arm, be more specific.
- Be clear as to what the appointment is for; evaluation and treatment is different than just an evaluation.
- Make it clear it is for a 1-time change that they are taking over the treatment.
When you send the appointment letter to the claimant, make sure to copy the claimant’s attorney and your defense attorney.
Even if the doctor is labeling it a “second opinion” for billing purposes, the letter needs to say it’s the 1-time change, and its for evaluation and treatment. Arguably if you set the appt as a “second opinion” you didn’t authorize a 1-time change timely.
Also, if the treating doctor refers a claimant out for a specific pain management treatment, such as injections, the authorization letter to that pain doctor is very important. It needs to be clear they are only authorized for that specific purpose and not to take over treatment.