INSURANCE CLAIMS: Internet Site Finds Docs for External Reviews
Expert Medicine, a new Internet company, facilitates lawyers in finding physicians to testify during health care trials and external reviews, the Florida Times-Union reports. Focused on the health insurance arena, Expert Medicine's contracted doctors review patient medical records to determine the necessity of medical procedures during the external grievance process of insurance claim reviews. Currently, 100 doctors in 33 medical specialties are working at the Jacksonville-based firm. Although a majority of company's cases address medical malpractice, Expert Medicine CEO Jorge Gamba said, "Our intent is to become an external review organization for the major HMO carriers." Consumers, however, will not have direct access to the doctors, as health insurers typically hire review physicians, Expert Medicine President Leanne Hartle noted. But, Hartle said, the doctor's "decision would be unbiased" because Expert, not the HMO, pays the doctors directly. The site offers brief biographies of all physicians, who undergo background checks and the company's credentialing process (Ostrow, 1/23).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.