Insurance Denial Trick?

[DianaCox]

I'm dubious, but it won't cost anything to try before filing an actual appeal. Saw this on the innerwebs - copied, except for my apparentlys and supposedlys. I don't know that this works.

The next time your insurance denies a test or procedure:

1. Call the insurance company and tell them you want to speak with their "HIPAA Compliance/Privacy Officer" (apparently, it is federal law that they are required to have one).
2. Then ask them for the NAMES as well as CREDENTIALS of every person who has accessed your medical record to make that decision/denial. Again supposedly by law, you have a right to that information.
3. They allegedly will almost always reverse the decision very shortly rather than admit that the committee is made of low paid HS graduates, looking at "criteria words," making the medical decision to deny your care. Even in the rare case it is made by medical personnel, it is unlikely that it is made by a board certified doctors in that specialty and they DON'T WANT YOU TO KNOW THIS!
4. Any refusal should be reported to the US Office of Civil Rights (OCR.gov http://www.hhs.gov/ocr/privacy/) as a HIPAA violation.

And please let me know how it goes!

Edited to correct the website for filing the HIPAA complaint.

 

[bearmom]

WARNING - SWEARING AND RAGE-Y-NESS TO FOLLOW!!!!



OMG it's like your reading my mind! I'm actually sitting here looking through a stack of medical crap right now.

I have been in Premera insurance hell since my back surgery like 4 months ago, and made an appt to talk to an atty about it today.

The past year they have just started denying everyfuckingthing just for the hell of it, and even though it's covered, it will take 4 - 7 or more hour long calls with them to sort out. And months. They are doing this for EVERY FUCKING iota. They have hired a company to (lie to) and call my husband at work with a ruse about someone else using my insurance, and after questioning, it turns out they are actually just trying to see if I have lied about having secondary coverage, or lied about the cause of the injury so they can deny.

I'm pissed and appalled they are spending resources to try to weasel out of their responsibility.

THANK YOU for posting this, as I'll give this a shot, but I'm not optimistic.

Thank god I have dual citizenship in Canada, because it's looking more likely that I need to get out of the US (especially if Trump is elected - omfg I can't even think about that).

 

[Munchkin]

Wow! VERY smart. I am impressed! Brilliant even.

 

[southernlady]

lied about the cause of the injury so they can deny.

That is common with back surgeries. They want to make sure it's not an automobile or a slip & fall covered by someone else.

I got that for both of mine. I just called them and said, nope, just bad genetics.

 

[Spiky Bugger]

WARNING - SWEARING AND RAGE-Y-NESS TO FOLLOW!!!!



OMG it's like your reading my mind! I'm actually sitting here looking through a stack of medical crap right now.

I have been in Premera insurance hell since my back surgery like 4 months ago, and made an appt to talk to an atty about it today.

The past year they have just started denying everyfuckingthing just for the hell of it, and even though it's covered, it will take 4 - 7 or more hour long calls with them to sort out. And months. They are doing this for EVERY FUCKING iota. They have hired a company to (lie to) and call my husband at work with a ruse about someone else using my insurance, and after questioning, it turns out they are actually just trying to see if I have lied about having secondary coverage, or lied about the cause of the injury so they can deny.

I'm pissed and appalled they are spending resources to try to weasel out of their responsibility.

THANK YOU for posting this, as I'll give this a shot, but I'm not optimistic.

Thank god I have dual citizenship in Canada, because it's looking more likely that I need to get out of the US (especially if Trump is elected - omfg I can't even think about that).

As to your last paragraph...it is my hunch that Trump will accomplish for the Repubs exactly what Nader accomplished for the Dems...that is, pull away enough extremists that the "real" establishment party loses. History DOES repeat itself. Well, I hope it does because my only other citizenship would be in Italy and I'm SURE they'd make me crazy.

 

[Spiky Bugger]

I'm dubious, but it it won't cost anything the try before filing an actual appeal. Saw this on the innerwebs - copied, except for my apparentlys and supposedlys. I don't know that this works.

The next time your insurance denies a test or procedure:

1. Call the insurance company and tell them you want to speak with their "HIPAA Compliance/Privacy Officer" (apparently, it is federal law that they are required to have one).
2. Then ask them for the NAMES as well as CREDENTIALS of every person who has accessed your medical record to make that decision/denial. Again supposedly by law, you have a right to that information.
3. They allegedly will almost always reverse the decision very shortly rather than admit that the committee is made of low paid HS graduates, looking at "criteria words," making the medical decision to deny your care. Even in the rare case it is made by medical personnel, it is unlikely that it is made by a board certified doctors in that specialty and they DON'T WANT YOU TO KNOW THIS!
4. Any refusal should be reported to the US Office of Civil Rights (OCR.gov) as a HIPAA violation.

And please let me know how it goes!

PS...and even IF the denial comes from an MD, GO ONLINE AND CHECK ALL OF HIS/HER CREDENTIALS!!!!

Mini Sue's breast reduction surgery was denied by Aetna...their in-house guy wanted her completely flat chested. "Our" reply was that it appeared that even though FIVE of their in-network, board certified plastic surgeons had made similar recommendations, their in-house guy...who appeared to be a board certified Otolaryngologist...disagreed, and we were good with appealing THAT to the state.

Immediate reply was close to, "Oh, there must be some misunderstanding...this was supposed to be APPROVED."

And then it was.

 

[BebeZed]

Thank god I have dual citizenship in Canada, because it's looking more likely that I need to get out of the US (especially if Trump is elected - omfg I can't even think about that).

Lucky you. If I'd qualified for emigration I would have done so years ago. I was just two stinkin' points and about $12,000 away. I could have gotten the points (basic French language skills would have put me over the top) but the $12k was more than I could have managed at the time and now I'm too old... sheesh. I was a brilliant illegal alien for a while though... took 'em a year to figure it out and invite me to go back from whence I came

 

[bearmom]

Southernlady - I figured that, but they have been given that info twice in writing, and I've talked to them numerous times, and now they are making up a ruse to call my husband twice. I think it should have been enough for me to give it to them in writing, and certainly verbally as well, but they are just making my husband more furious by interrupting meetings claiming it's an important call from a "friend". It should be enough.

Spiky - it's funny you say that, because "Oh, there must be some misunderstanding...this was supposed to be APPROVED." is pretty much verbatim what they have told me - 4 times.

 

[southernlady]

but they have been given that info twice in writing, and I've talked to them numerous times

Don't you know that anything in writing to an insurance company disappears into the black hole never to be seen again?

 

[Joyouslyme]

@DianaCox I tried this Friday. BCBSIL doesn't have a HiPAA officer. They have a HIPAA department. I have to mail in the request. They couldn't provide me with the first name or credentials of the doctor who denied me either. Just J. Blackstone MD. I tried to Google that and came up with nothing.

 

[DianaCox]

Send in the request - they have to answer. And file a complaint to http://www.hhs.gov/ocr/privacy/.

 

[BebeZed]

I'm dubious, but it it won't cost anything the try before filing an actual appeal. Saw this on the innerwebs - copied, except for my apparentlys and supposedlys. I don't know that this works.

The next time your insurance denies a test or procedure:

1. Call the insurance company and tell them you want to speak with their "HIPAA Compliance/Privacy Officer" (apparently, it is federal law that they are required to have one).
2. Then ask them for the NAMES as well as CREDENTIALS of every person who has accessed your medical record to make that decision/denial. Again supposedly by law, you have a right to that information.
3. They allegedly will almost always reverse the decision very shortly rather than admit that the committee is made of low paid HS graduates, looking at "criteria words," making the medical decision to deny your care. Even in the rare case it is made by medical personnel, it is unlikely that it is made by a board certified doctors in that specialty and they DON'T WANT YOU TO KNOW THIS!
4. Any refusal should be reported to the US Office of Civil Rights (OCR.gov http://www.hhs.gov/ocr/privacy/) as a HIPAA violation.

And please let me know how it goes!

Edited to correct the website for filing the HIPAA complaint.

Snopes and other sites says this isn't exactly true - there's some false information included in the above.
http://www.snopes.com/hipaa-medical-hack-insurance-claim-denials/

http://hipaahealthlaw.foxrothschild...egorized/debunking-a-viral-medical-hack-meme/

 

[Spiky Bugger]

@DianaCox I tried this Friday. BCBSIL doesn't have a HiPAA officer. They have a HIPAA department. I have to mail in the request. They couldn't provide me with the first name or credentials of the doctor who denied me either. Just J. Blackstone MD. I tried to Google that and came up with nothing.

So...instead of underpaid HS grads, they hire underpaid new doctors with many student loans or retiring old farts?

Just enter "Blackstone." If THEIR "J Blackstone" is this guy...he's in the old fart category...first licensed in Kentucky in 1975...and an OB/GYN by trade. He's been in IL for five years.

https://www.idfpr.com/applications/professionprofile/Default.aspx?AspxAutoDetectCookieSupport=1

 

[DSRIGGS]

That is common with back surgeries. They want to make sure it's not an automobile or a slip & fall covered by someone else.

I got that for both of mine. I just called them and said, nope, just bad genetics.

Oh if possible I would fucking move to Italy tomorrow. Love that place for numerous reasons, but vino and the food are just two.

Regarding Trump, it is has been my contention all along is that his job was to make they eventual GOP nominee look less radical and I think that is exactly what is going to happen. Kasich or Rubio will be the nominee, IMO. Kasich is somewhat moderate, Rubio I don't trust as far as I can throw him but I will still vote for Clinton or Sanders over that ticket because the idea of the GOP having the house, the White House and under that scenario probably the Senate as well, scares the bejeebers out of me. The GOP has run so far away from me over the last 20 years.

 

[Joyouslyme]

@Spiky Bugger thank you so much! That's him. I found a Flickr page where he states that he recently became a consultant with them.