Pre-x investigation procedures

[Guest sylvia]

I was wondering how small TPA's out there go about investigating pre-existing conditions. I am referring to those instances where the exclusion period isn't nicely eliminated by a certificate of creditable coverage.

I have heard of getting the patient's primary physician to sign a statement regarding the lookback period. I always figured the statement should go to the member to sign, since the member is the only one with knowledge of all treatment (in the case of more than one treating physician).

I suppose doing both would be the ideal, but that is double the work with the letters.

Any opinions?