Why seek an Independent Medical Evaluation?
Independent Medical Evaluations (IMEs) can help carriers learn about diagnosis, causation, proper treatment, and functionality. If insurers have concerns that previous treating professionals and other experts have not accurately assessed these issues, an IME can help.
Why not seek a budget IME?
Insurance companies reasonably ask what might be done to reduce the cost of IMEs. One avenue is to search for budget evaluations, which sometimes yield solid results. However, all too often, they give the mistaken impression that a thorough assessment was performed. Unfortunately, these evaluations can lead insurance companies to make the wrong claims decisions. Therefore, insurers should carefully reconsider decisions to give priority to cost rather than quality.
Why should I use PsyBar for IMEs?
When insurers refer to PsyBar, they gain confidence knowing that a skilled expert, perhaps working exclusively with PsyBar, will perform a thorough assessment. We achieve this through unique quality control measures. We offer consultation and education to our doctors to decrease the potential for error. Our consent and release forms not only address release of information issues, but also the nature of the evaluation, potential uses of the information obtained, and other legally-mandated issues. Collectively, these measures increase the value of IMEs and minimize risk.
What do I do if I have a claimant raised in a foreign culture or who speaks another language?
PsyBar has the nation’s first, and perhaps only, IME assessment plan for claimants from different cultures. Developed with leading experts in cross-cultural assessment, this protocol helps insurers follow fair claims practices, protect claimant civil rights, and make impartial and supportable claim decisions.
What if I don’t know what to do about evaluating a claimant with psychiatric issues?
Call PsyBar, and you will be transferred to one of our in-house psychologists to answer your questions.
What are some ways I can ensure a cost-effective IME?
- Count the number of addenda required for each vendor because initial reports were not clear, were inconclusive, or were poorly thought out. Requests for multiple addenda or repeated reviews may be perceived as pushing the reviewer(s) for an answer that will save the insurer money, thus inviting expensive bad faith and unfair claims practices litigation. To minimize indirect costs, maintain emphasis on quality over originally quoted price.
- Have each report rated by an internal insurance doctor or nurse who is medically sophisticated in the specialty of the review. Ask them to consider clarity of expression, inclusion of objective data, and solid support for the final opinions expressed.
- Ask how the vendor assists their doctors in meeting current practice standards. IME/File Review vendors should offer their doctors ongoing continuing education to ensure they maintain optimal standards of practice.
- Determine who actually looks at report drafts during the vendors’ draft review process. Some vendors who claim that their QA process is performed by doctors have doctors in place only to oversee the QA area. Less qualified individuals actually read the reports. While this saves the vendor money, the risk is that critical errors, potentially damaging to claimants and expensive for insurers, will slip by their QA measures.
- Determine how detailed vendors’ formal performance expectations are for their expert panels. Vendors who send reviewing doctors only cursory instructions on how to prepare their reports may receive only cursory reports, which could increase the number of addenda requests, repeat reviews, and raise costs even to the point of settling or litigation.
- Insist that objective psychological testing be available for every behavioral health IME. Psychiatrists do not typically administer psychological tests. A good vendor’s QA program offers clients the option to have a psychologist work with a reviewing psychiatrist, and supplement IMEs with tests such as the MMPI-2-RF. Measurable tests add objectivity and validity to the assessment. For a very reasonable cost, this additional insight enhances the reviewing doctors’ ability to firmly support the right opinion. Solid substantiation with the first review adds clarity to claim direction/decisions and decreases defense costs.
- Inquire if the IME vendor offers formalized assessment options, including detailed culturally sensitive assessment protocols, for claimants whose native language is other than English. Culturally sensitive assessments protect claimants’ rights and protect the insurer from potential litigation.
- Look at turnaround times pragmatically. Faster is not necessarily better. Often, a little extra time allows your vendor to retain doctors who are particularly skilled (and likely booked farthest into the future). Your result is a more thorough report.
- Asking claimants or reviewing doctors to travel initially costs more. Quality vendors look for the most competent reviewer. Ask vendors to explain their doctor selection process, including when they might recommend travel even if a local expert is available.
- Determine how many claims from each vendor go for costly appeals and litigation. How often does the appeals area need to request additional independent opinions? Higher numbers from any given vendor might indicate poor quality evaluations. Expensive settlements and litigation are often the price of mediocrity.
