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<p class="MsoNormal"><span style="color:#1F497D">I think you should discuss this with an attorney well versed in HIPAA. All that glitters is not gold.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">John Riley<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
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<td colspan="2"><span style="FONT-SIZE: 10pt; FONT-FAMILY: arial; FONT-WEIGHT: bold; COLOR: black; BACKGROUND-COLOR: white">John M. Riley, III</span></td>
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Principal | Witherspoon • Kelley</td>
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<a style="COLOR: #17365d !important" href="http://www.witherspoonkelley.com/john-riley-1">
Attorney Profile</a> | <a style="COLOR: #17365d !important" href="http://www.witherspoonkelley.com/s/jmr.vcf">
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422 W. Riverside Ave, Ste 1100<br>
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(509) 624-5265 (office)<br>
(509) 458-2728 (fax)<br>
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<p><em><span style="FONT-SIZE: 7pt; FONT-FAMILY: 'Arial','sans-serif'; COLOR: gray; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA">Confidentiality Notice: The information contained
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> wsbarp-bounces@lists.wsbarppt.com [mailto:wsbarp-bounces@lists.wsbarppt.com]
<b>On Behalf Of </b>Carl L. Gay<br>
<b>Sent:</b> Monday, December 21, 2015 2:24 PM<br>
<b>To:</b> listserve real property; listserve elder law<br>
<b>Subject:</b> [WSBARP] off topic query: how to help a client whose insurance company denied payment for prescribed services/treatment<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
<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">clgay@tfon.com</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
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<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Californian FB","serif"">Facsimile (360) 452-3724
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