Insurance adjusters pounce on gaps in treatment and hold onto them for dear life. The adjusters translate a gap in treatment to mean the injured party was not really injured. If the person was truly injured, he or she would have gone to the doctor.
Full Answer
What is a gap in treatment?
A gap in treatment is a period of time where a patient misses treatment with one of their health care providers. For example, missing your physical therapy session or failing to go back to your doctor for follow-ups.
What is a gap in treatment in a personal injury claim?
Secondary to that, if you decide to file a personal injury claim, a gap in treatment could lessen your compensation greatly. What's a Gap? There are two types of gaps in treatment; one is the gap between when you got in the accident and when you first start treating injuries from that accident.
Why is there a gap in my appointment schedule?
Sometimes a gap simply cannot be avoided. You may experience a sickness or illness that prevents you from making your appointments. For example, maybe you had an unrelated surgery that required extended healing time, that would be an acceptable explanation for the gap.
Can outreach strategies help solve HEDIS care gaps?
When the right outreach strategies are applied to HEDIS care gaps, patients will take action. At Carenet Health, our approach to healthcare engagement is known as Intelligent Engagement, a process rooted in human interaction, reliable data, advanced technology and engagement best practices from inside and outside of healthcare.
What happens if you have a gap in your medical history?
If you know that you have gaps in your treatment history, it’s best to seek out help at the beginning of your application.
Is there a gap in disability?
Sometimes you want a break, and other times it’s challenging to get your doctor moving onto the next step. When you consider the many people and facets involved in medical treatment, there will probably be a gap in your treatment. Social security disability cases always come with some struggle. If you already have an open application with the Social Security Administration for disability, you may feel even more pressure. The pressure to keep on top of your medical care and keep the recovery process moving is not your sole responsibility.
Can mental illness cause gaps in treatment?
Mental disability often leads people to have gaps in their medical treatment. Many doctors go so far as to say that avoiding treatment is a possible symptom of an underlying mental disorder or disability. If you have a significant gap or a series of gaps between treatment, you should have your doctor comment on your mental capacity to seek out treatment.
What is a Gap in Treatment?
Insurance companies deny and shortchange personal injury claims when the records show a delayed medical treatment. The term “Gap in Treatment” is insurance industry lingo. It means there has been a long period of time between an injury and when you go to the doctor or hospital. Or alternatively, a long delay between one medical visit and the next.
Why a Gap in Treatment Might Affect Your Claim
In a situation where you don’t get immediate medical attention insurance adjusters can assert this as proof that the injuries you are treating of claiming in the case are less severe than you say. The same argument is made when after you first visit the hospital or private doctor you delay or don’t follow their direction to get follow-up care.
A Gap In Treatment Often Happens For Legitimate Reasons
Car crashes, truck collisions , product injuries, bike wrecks and other injury accidents result in all kinds of damage to people’s bodies. Some is obvious and some injuries do not appear immediately. Or some may not be sensed right away.
Medical Care is Different In An Injury Case Setting
Get the treatment you need in an injury case. Follow your doctors orders. You will eliminate one set of potential issues if you seek medical care right away and follow-up as required. Your medical documentation is a very important part of any personal injury claim.
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Why do I have a gap in my treatment?
A gap in treatment does not mean you are not injured. Chances are that if you have a gap in treatment it was not because you weren't experiencing pain and problems. Sometimes a gap simply cannot be avoided.
Why is it important to avoid gaps in treatment?
Put simply, your health and well-being are the most important reason behind avoiding gaps in treatment. When you have injuries from an accident you may be living with them for the rest of your life. The severity may lessen with treatment, but chances are the residual effects will continue to affect you. It is in your best interest to take care of your health and stick with the treatment your doctor suggests, and if you do decide to file a claim it will really help your case.
Why is it important to keep up with appointments?
It is extremely important that you keep up with these appointments, because consistency of care is going to benefit you greatly. Secondary to that, if you decide to file a personal injury claim, a gap in treatment could lessen your compensation greatly.
Why do people delay medical treatment?
The two most common reasons why people have delayed medical treatment in an injury case are: 1. Their pain is not greater than the “inconvenience” in getting medical treatment. Many clients who I have settled cases for have told me that they did not have the time to see or follow-up with a doctor. I try to be as sympathetic to this as possible ...
Does delay in treatment affect settlement?
A delay in treatment may not affect your settlement if the value of your case, after all reductions, is greater than the available liability insurance coverage. I settled a case involved in a herniated disc for $16,500 (gross) with Geico.
Can you pay a medical provider for a LOP?
You may have to pay the medical provider – who treated you on an LOP – more than you would have to repay your health insurance company. This means that your net settlement may possibly be reduced.
What is Carenet's approach to healthcare engagement?
At Carenet Health, our approach to healthcare engagement is known as Intelligent Engagement, a process rooted in human interaction, reliable data, advanced technology and engagement best practices from inside and outside of healthcare.
How does coordination help in HEDIS?
Typically this is done through a three-way conference call. Coordination also requires providing multiple options for in-network provider selections.
