[WSBARP] off topic query: how to help a client whose insurance company denied payment for prescribed services/treatment

[John M. Riley III]

I think you should discuss this with an attorney well versed in HIPAA.   All that glitters is not gold.

John Riley



John M. Riley, III
Principal | Witherspoon * Kelley
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From: wsbarp-bounces at lists.wsbarppt.com [mailto:wsbarp-bounces at lists.wsbarppt.com] On Behalf Of Carl L. Gay
Sent: Monday, December 21, 2015 2:24 PM
To: listserve real property; listserve elder law
Subject: [WSBARP] off topic query: how to help a client whose insurance company denied payment for prescribed services/treatment


Dear Colleagues,



I subscribe to a medical listserve and someone posted the following "advice" regarding what to do if an insurance company elects to deny payment for doctor-ordered care. I am curious if any of you who is familiar with HIPPA has been presented with such a situation and whether these steps have led to success.  If this is an available remedy under HIPPA, I would think it could be of great benefit to our clients. Thank you for your thoughts.



Best regards,

Carl Gay





Steps to take when health insurance company refuses to pay for prescribed services/treatment.



Your doctor ordered a test or treatment and your insurance company denied it. That is a typical cost saving method. OK, 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 for the Names as well as Credentials of everybody accessing your record to make that decision of denial. By law you have a right to that information.



3. They will almost always reverse that decision very shortly rather than admit that the committee is made-up of low paid high school graduates who are trained to look for "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 and THEY DO NOT WANT YOU TO KNOW THIS.



4. Any refusal should be reported to the U.S. Office of Civil Rights (OCR.gov) as a HIPAA violation.


CARL LLOYD GAY
GREENAWAY, GAY & TULLOCH
Attorneys and Counselors at Law
829 East Eighth Street       Suite A
Port Angeles, Washington   98362
Email                      clgay at tfon.com<mailto:clgay at tfon.com>
Telephone               (360) 452-3323
Facsimile                  (360) 452-3724

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