HIPAA Medical Hack: How to Get a Medical Insurance Company to Pay for a Test or Treatment They Denied
Adam Rifkin stashed this in Personal Finance
HIPAA Medical Hack:
So your doctor ordered a test or treatment and your insurance company denied it. That's a typical cost saving method.
So here is what you do:
1. Call the insurance company and tell them you want to speak with the HIPAA Compliance Privacy Officer. (By Federal law, they have to have one)
2. Then ask them for the names as well as credentials of every person accessing your record to make that decision or denial. By law you have the right to that information.
3. They will almost always reverse the decision very shortly rather than admit that the committee is made up 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 doctor in that specialty field 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: http://ocr.gov/
CLAIM: Patients can circumvent insurance company claim denials by requesting a specific form of documentation, as the insurance company will opt to simply cover the cost rather than provide the paperwork.
WHAT'S TRUE: HIPAA laws entitle patients to access to their medical records (with limited exemptions); insurers unable to document adherence to healthcare laws could conceivably reverse a denial decision to avoid hassle.
WHAT'S FALSE: Federal laws mandate all documentation stipulations in the meme; denials must be decided by a physician or specialist.
WHAT'S UNDETERMINED: Whether many assertions in the meme truly are rights mandated by federal law; whether inherent legal flexibility to those laws provided large enough loopholes to render its claims meaningless.
Source and more: http://snopes.com/hipaa-medical-hack-insurance-claim-denials/