One of the tasks that MACRMI members tackle is development of resources to help those who have CARe or CRP programs -- or are planning to have one shortly. As the programs become more robust and more common, we often get questions like "How do I handle this?" or "What would you say in this situation?"
One very common question from those who attended our Forums or who have reached out to us for help developing their own CARe program is, "What do I say when I want to tell the patient that our investigation found that there were some problems and we want the insurer to review their case?" This is always challenging because an insurer review does not always mean that there is a certainty that the standard of care was not met, and it also does not necessarily mean that compensation is warranted. Therefore, healthcare administrators want to set proper expectations while still urging the patient to have their care reviewed by the insurer to see if there is more they can do to help them.
So MACRMI took on the task, and over several months developed its Guide to Insurer Referral Conversations, which can be found in our Resource Library, or by direct link here: https://www.macrmi.info/download_file/262/.
We hope it is useful to you!