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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoPlainText>Dear Colleagues,<o:p></o:p></p><p class=MsoPlainText><o:p> </o:p></p><p class=MsoPlainText>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.<o:p></o:p></p><p class=MsoPlainText><o:p> </o:p></p><p class=MsoPlainText>Best regards,<o:p></o:p></p><p class=MsoPlainText>Carl Gay<o:p></o:p></p><p class=MsoPlainText><o:p> </o:p></p><p class=MsoPlainText><u><o:p><span style='text-decoration:none'> </span></o:p></u></p><p class=MsoPlainText><u>Steps to take when health insurance company refuses to pay for prescribed services/treatment.<o:p></o:p></u></p><p class=MsoPlainText><o:p> </o:p></p><p class=MsoPlainText>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:<o:p></o:p></p><p class=MsoPlainText><o:p> </o:p></p><p class=MsoPlainText>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).<o:p></o:p></p><p class=MsoPlainText><o:p> </o:p></p><p class=MsoPlainText>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.<o:p></o:p></p><p class=MsoPlainText><o:p> </o:p></p><p class=MsoPlainText>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.<o:p></o:p></p><p class=MsoPlainText><o:p> </o:p></p><p class=MsoPlainText>4. Any refusal should be reported to the U.S. Office of Civil Rights (OCR.gov) as a HIPAA violation.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal style='text-align:justify;line-height:15.0pt;mso-line-height-rule:exactly;page-break-after:avoid;text-autospace:none'><span style='font-size:12.0pt;font-family:"Bradley Hand ITC";letter-spacing:-.1pt'>CARL LLOYD GAY</span><span style='font-size:12.0pt;font-family:"Palace Script MT";letter-spacing:-.1pt'> <o:p></o:p></span></p><p class=MsoNormal style='text-align:justify;line-height:15.0pt;mso-line-height-rule:exactly;page-break-after:avoid;text-autospace:none'><span style='font-size:12.0pt;font-family:"Bell MT","serif";letter-spacing:-.1pt'>GREENAWAY, GAY & TULLOCH<o:p></o:p></span></p><p class=MsoNormal style='text-align:justify;line-height:15.0pt;mso-line-height-rule:exactly;page-break-after:avoid;text-autospace:none'><span style='font-size:12.0pt;font-family:"Californian FB","serif";letter-spacing:-.1pt'>Attorneys and Counselors at Law <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Californian FB","serif"'>829 East Eighth Street Suite A<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Californian FB","serif"'>Port Angeles, Washington 98362<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Californian FB","serif"'>Email <a href="mailto:clgay@tfon.com"><span style='color:blue'>clgay@tfon.com</span></a><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Californian FB","serif"'>Telephone (360) 452-3323 <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Californian FB","serif"'>Facsimile (360) 452-3724 <o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='font-size:8.0pt'>THIS EMAIL TRANSMISSION IS INTENDED FOR THE EXCLUSIVE USE OF THE INDIVIDUAL OR ENTITY TO WHOM IT IS ADDRESSED, AND MAY CONTAIN PRIVILEGED AND CONFIDENTIAL INFORMATION THAT IS COVERED BY THE ELECTRONIC COMMUNICATIONS PRIVACY ACT (18 USC §§ 2510-2521). IF YOU ARE NOT THE INTENDED RECIPIENT OR AGENT RESPONSIBLE TO DELIVER THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION, OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR; PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE AND/OR EMAIL AND DELETE THE ORIGINAL MESSAGE. THANK YOU <o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>