What Medical Providers Should You Canvass?

Medical canvassing is a helpful process of scouring through a claimant’s medical history by contacting past providers and obtaining a comprehensive medical background on the claimant.

Assessing the validity of the claim and preventing fraud is the goal behind medical canvassing.

Professional canvassers will contact all types of clinical and medical providers in the surrounding current and past areas where the claimant has resided. They will collect interviews, obtain statements from witnesses, surveillance to gather evidence.

How Does Medical Canvassing Get Around HIPAA Regulations?

HIPAA regulations, subpoenas, and authorization don’t apply to medical canvassing which makes it a lucrative service to discover a claimant’s medical history quicker.

In our learning center blog, We discuss the HIPAA relationship with medical canvassing in further detail.

What Types of Medical Providers Can Be Canvassed?

The type of providers that should be canvassed during an investigation depends on the injury. For example, if you receive a case with the insured claiming neck and back soft tissue injury, there wouldn’t be much need to canvass nearby dental providers or a cardiologist.

The most common provider types are:

1. Hospitals
2. Health clinics
3. Urgent care centers
4. Primary care clinics
5. Pharmacies

The benefit of canvassing these providers first is that we can uncover more common, and urgent reasons for a doctor’s visit. This can help your case move faster and incentivize further surveillance or further canvassing

Pharmacy Canvassing:

Pharmacies serve as a great source of relevant medical information during the investigation phase before finalizing a case payout.

Did you know: Canvassing a pharmacy can gain you access to treatment dates AND medication usage?

One of the most useful reasons to conduct a pharmacy canvass is you can confirm who the prescribing physician is without asking for any private, protected medical information.

This type of canvassing will provide insight into the types of medications prescribed, dosages, possible existing conditions, and duration of treatment.

Pharmacy Canvassing: Red Flags

In general, there are red flags during a medical canvassing you should look out for. We talk about them in further detail in our medical canvassing blog. But for now, we will focus on pharmacy-specific canvassing red flags.

These red flags include:

• Excessive or prolonged use of medication
• Frequent changes in prescribing physicians or pharmacies
• Patterns of drug-seeking behavior
• Discrepancies between reported injuries and the prescribed medication

Canvassing Specialty Providers

Let’s dig deeper into the wealth of information that specialty providers can contribute to your canvassing journey:

Diagnostic Imaging:

These providers offer services like X-rays, MRIs, and CT scans. By connecting with them, we can gather crucial imaging-related treatment information.

Primary Care Physicians:

Because these are generally the trusted sources for routine check-ups and general medical care, you can obtain a comprehensive overview of the claimant’s medical history.

Orthopedic Specialists:

When it comes to musculoskeletal injuries and conditions, orthopedic specialists are the go-to experts.

Chiropractors:

Chiropractic care focuses on spinal health and alignment. The reasons for going to a chiropractor can vary, from a car accident to general back pain issues – so discovering the reasons a person may have gone there can be very informative.

Pain Management Specialists:

For individuals experiencing chronic pain, pain management specialists play a critical role. These are often in conjunction with chiropractic facilities.

Physical Therapy Providers:

Physical therapists assist individuals in recovering from injuries and improving physical functionality.

Cardiologists:

Cardiologists specialize in heart-related conditions and treatments.

Neurologists:

Neurologists focus on the nervous system, including the brain and spinal cord.

Dental Providers:

Dental health is an integral part of overall well-being.

Clinical Labs:

These providers conduct various diagnostic tests and examinations. Information about laboratory testing can be useful, including blood panel workups, or hormone-related facilities.

Gym/Fitness Clubs:

People can go to the gym to workout, but gyms also provide other kinds of rehabilitation programs. Outside of the specialist facilities, there are often chiropractors, pain managers, mobility specialists, or other forms of rehabilitation performed on site.

Medical Release Requirements

It’s important to note that certain providers require a medical release to provide treatment dates. These include psychology and physiatry (physical medicine and rehab to restore functional abilities), psychiatry, veterans’ affairs, and providers offering treatments for minors. These places often have additional privacy regulations in place, so obtaining information is trickier and oftentimes not possible.