| I’ve saved a message that was reposted by Bill Ackman on dealing with denials. Thankfully, never had occasion to use it yet: >> So, 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 them for the NAMES as well as
CREDENTIALS of every person accessing your record to make that decision of denial. By law you have a right to that information. 3. They will almost always reverse the decision very shortly rather than admit that the committee is made 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 and they DO NOT WANT YOU TO KNOW THIS!! 4. Any refusal should be reported to the US Office of Civil
Rights (http://OCR.gov) as a HIPAA violation. |