Question
state of florida
my wife went on std for one week due to work-related stress. she was prescribed the usual anti-depressants, etc. by her pcp. we filed a claim for std with her insurance company. a licensed social worker initially denied the claim, and her physician convinced them to reconsider. the claim was denied because "the provider did not provide an axis one diagnosis, do a mental status exam, pyschological testing, global assessment, or observation that would document the intensity of the symptoms. based upon careful <yeah, right> review of the medical information received, we have concluded that the objective data received does not support you being disabled."
we are in the process of appealing. any advice?
Answer
Unlike the way it worked in high school, a "note from the doctor" is NOT sufficient for an insurance company, nor should it be, unless the doctor is highly qualified -- and most pcp's are not psychiatrists -- and/or provides sufficient support for the diagnosis (such as with standard tests or other measures another professional could review).