questions about IME's

  1. 0
    I have had some weird expereinces in doctor's offices. I got embarrassed to death by a nasty secretary who didn't understand the role of the case manager, and told me I would have to wait for the doc's writen report, couldn't attend, even tho pt said it was OK.

    So, I went to the IME web site, I forget the exact link, but american borad of IME something.com and I don't see any regulations for this practice, ie, can CM be present during exam? etc.

    So, what is your expereince? Do you observe the exam? Is there a form you request the doc fill out? Does anyone know if there is a specific guideline to be followed for IME exams? I never say a word during the exam, unless the pt asks me to clarify something to the doc, and then only at the end, re findings and recommendations? I don't contribute anything other than the med recs already sent, so the exam is unbiased.

    That's another gripe I have! So many times I have busted my arse to obtain and send them records, and they don't review them prior to the exam, then they do ask me dozens of questions, which are all in the records I sent. I find this aggravating. Do you think they are trying to be unbiased, and that is why they don't read the records?? I have found it very difficult to get any cooperation from the docs who request pre-pay. I guess they figure they have you by the ba!!s, since they already have their money.

    I recently went to a reknowned facility for a spinal IME, it was a pre-pay. Doc barely gave me the time of day, after I wated almost 2 hours to speak to him, then submitted the WORST report I have ever read. I was appalled. He came so highly recommended, I was shocked! Not to mention embarrassed. PLUS his report was completely different from what he told me verbally, the pt could RTW w no restrictions, in his report he said RTW w 50% travel restrictions. I was so upset. And this is one of our meanest accounts to work for. I have since had to wrote letters to try to communicate and clarify info, he has yet to return any messages.

    How do you get good info while at an IME when docs haven't read the medical rec's and won't commit to signing anything in writing at the appt?? Newbie needs help.

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  2. 0
    I can't speak for states other than California and Nevada, but here no one is allowed to attend IME exams. And, in most instances we are not allowed to send any correspondence until AFTER the exam has taken place to clarify certain issues. Here, the IME is considered admissable as evidence. Therefore we cannot do anything that would be felt to influence the exam.

    You have to really know your states regulations - they differ greatly!
  3. 0
    Hoolahan,
    I think this probably varies from state to state. I do attend IME appointments but am not present in the exam room. I always send the records and a letter to the IME doc prior to the appointment, and always speak to the physician before and after the IME. If something is ommited in the IME report or needs to be clarified, then I will call the Dr. or fax him a letter asking him to address what I need. Of course, part of this W/C game, is that you have plaintiff and defense docs, and as a case manager for an insurance co., you need to have a Dr. who works well on defense.

    Of course the IME is admissable as evidence, but so is everything else, including your progress reports.

    I would take this bozo off of my list of IME docs if I were you. I guess I am lucky to work in a state where CMs are respected by the docs and the attorneys. And I rarely have any difficulty getting what I need from the docs I work with.

    Kim
  4. 0
    Oh believe me Kim, he is on my do not use list. Unfortunately, this list is growing, to include 2 docs who reamed me a new one for re-directing their pt's care, at the req of the insur co (in NJ we can direct care). Both times, they had their office nurse/manager call and harrass me a few times, then they repeatedly called themselves. One doc was SO obnoxious, I wrote a brief letter explaining the transfer of care, and deliberately cc'd it to the plaintiff's attorney, just so he wouod squirm! I have been really beaten up a few weeks ago, and I am getting a tough skin.
  5. 0
    Hopefully you'll see the humor in this...

    I'll skip the 9 year tale of my blown back & 5 failed surgeries...btw, I have been off work a total of 2 of the 9 and none since '96, thanks to a great pain mgmt Doc & my Qwickie

    anyway

    My 5th WC claims manager in 6 months just scheduled my 6th IME in 10 months, but she didn't notice that the Ortho & Neuro she scheduled it with are my attendings (well DUH!) "I thought the name sounded familiar".

    The good news is she cancelled it & is letting me start fresh with a brand new Neurosurgeon (my attendings are semi-retired and don't do backs anymore).
  6. 0
    It doesn't surprise me that there is a high turnover in WC. Pretty sad that you have to correct the newbies on not doing IME w your own attending! I had a similar expereince last week, had to schedule an oral surgeon IME, very hard to find one in the pt area, who accepted WC. One I called would do it but wanted $650 up-front, and another $150-250 to write the report. Found another one, was thrilled, turns out the pt already had gone to him herself, so I HAD to use the $$$ one anyway. Glad it turned out the way it did. First guy, the treating wanted to do very invasive surgery. IME guy said no WAY he would consider surgery, and if so, it would be laprascopic, and not invasiveat first. So, at least I can justify the cost by avoiding surgery now. Sounds like the first one turned out to be a bit of a quasck, even the pt thought so!

    Nine IME's?? I hope they finally believe you!
  7. 0
    Originally posted by hoolahan
    Nine IME's?? I hope they finally believe you!
    6 IMEs...and its not me they need to believe...the Docs need to make up their minds...there is still a 50:50 split on fusion -vs- wait and see...love the fact that a couple have said the severity of my subjective sx are "not consistant with the MRI". No shyt...the MRI is 3 years old. I'm just counting the days until my appointment with my "new" doctor. The last year has just been a cluster-you-know-what.

    BTW, the WC is a privately insured, not the State.


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