While watching Kim Iversen for my daily news fix, this tidbit of information regarding health insurance claims came up and I thought I’d share it.
Here’s what to do if your doctor ordered a test or treatment that was rejected by your health insurance company:
- Call the insurance company and ask to speak with the HIPAA Compliance/ Privacy Officer. Federal law requires them to have one.
- Ask for the names and credentials of every person accessing your file to make the denial decision. You have a right to this information by law.
In most cases, the denial decision will be reversed simply by making these inquiries. Decisions regarding the approval or denial of these medical claims must be made by medical personnel with that specific specialty. Often, insurance companies will employ low-wage individuals without a medical background to make these decisions. If they use board certified doctors (which is rare), they will not have the specialty required to make a decision on your treatment. And I wouldn’t be surprised if insurance companies have begun to use AI to make these decisions.
Also, any refusals should be reported to the US Office for Civil Rights as a HIPPA violation.