Insurance Consulting

Posted on by PRN | 8 Comments

Are you interested in learning about consulting for insurance companies? Here is an entry by Joe Lee, MD, a Physical Medicine and Rehabilitation expert and PRN member, regarding his experience in this area.

 

I got involved in utilization review consulting by chance.  I had interviewed for a position at a hospital and met another physician there while touring the facility.  Later on I contacted him in regards to the hospital, and he asked me whether I had any free time to do some consulting.  He was the medical director of a division of an insurance company who needed physicians in certain specialties to review treatment requests and make recommendations on those requests.  In addition case managers might need help in resolving some issue or have questions on a specific case, and he needed physicians to help with these cases.

 

The work requires board certification, access to a high speed internet connection and some working computer knowledge.  I had to undergo some training with the software prior to reviewing chart notes which are provided over the internet.  The chart notes could vary from copious illegible notes to easily readable typed reports to hardly any notes at all.  The company wanted consultants to be able to review 2 cases per hour.  Online guidelines were provided to help with the recommendations and could be used depending on the circumstances of the case.  Clinical experience could also used in conjunction with these guidelines, especially when there was no guideline that would be applicable.  References have to be provided to justify the recommendations, and the requesting physician has to be contacted about the recommendation.  References can usually be found in the online guidelines but could also be obtained from the PubMed website.  Two attempts should be made to contact the requesting physician by phone at least 3 hours apart if possible before no further attempts would be made.  Documentation is very important, especially in terms of the reasoning and the references used to come up with the recommendation.  Any conversation or attempted contact with the requesting physician also needs to be documented.  If the reviewing physician does not do any clinical work, then a practicing physician needs to supervise the work of that reviewing physician.

 

Overall, utilization review work as described can provide supplemental income to a clinical practice.  The expenses if separable from other expenses can be tax-deductible.  The volume of work can be cyclical similar to clinical work, declining during holiday time.

 

                                                                           Joe Lee, MD

Comments (8)

  1. marcus wells says:

    Please, send me more information about insurance consulting as a physician

  2. Mike says:

    Any recommendations on specific companies or websites to contact regarding these types of jobs?

  3. Jim Wood, MD says:

    I have a similar story in that I came across utilization review by accident when I was a fellow trying to supplement my income. I have continued to do more and more of it over time since I’ve been in practice. It is enjoyable, can be done for the most part when is convenient given that I practice full time, and is intellectually challenging. Might we compare the names of companies we work with in order for both of us to gain new contacts for additional work?
    Thanks

  4. R. John Naranja Jr., MD says:

    Hi Dr. Lee,
    I read your interesting article and wonder if I could get more details on how to participate in this type of utilization review?
    R. John Naranja Jr., MD

  5. Terry J. Brown says:

    Hi,
    I’m Board Certified in PM&R and left practice 12 years ago to go to culinary school. I now own a high end wine shop. Do you think there’s any chance that I could pick up some extra work in the insurance industry? Thank you so much for your help!

    Regards,

    Terry

  6. Joe Lee says:

    I spoke to Jim Wood. He had mentioned to me the MES group which does require at least 8 hours of clinical work for PM&R peer review work done in Massachusetts. I also contacted the MLS National Medical Evaluation Service which does peer reviews, IMEs, FCEs. A clinical office is needed for their IMEs. I have not done work for either of these companies, but they may worthwhile checking into if you do 8 hours of clinical work and/or have a clinical office.

    I do some work for another company, but the volume of work has slowed down during the holidays.

    A current license and board certification are required.

    I hope this information helps.

    Regards,
    Joe

  7. Joe Lee says:

    I received a letter a few weeks ago from Medical Review Institute of America. They were seeking board certified dermatologists to perform medical chart review. I have never worked with this company.

    Minimal requirements:
    Actively practicing, current state licensure, specialty board certification, high speed internet connection and understanding of current medical literature.

    The contact person was
    Michele Bennett
    Director / Reviewer Relations
    800-654-2422 ext 432
    fax 888-301-8259
    michele.bennett@mrioa.com

  8. Phil Calenda says:

    Joe,
    Great article! I’m a Board Certified Ophthalmologist in Clinical Practice. Do you know any companies involved in medical chart reviews that I can approach for this kind of work? Is there some central database of such companies? Thanks a lot. Good luck with everything.

    Phil Calenda

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