ThatFLGuy
Member
So, your doctor orders tests, procedures, or medical equipment, and your insurance says no. What do you do?
1) Call the insurance company and demand to speak with the Hippa Compliance/privacy officer (They have to have one by law)
2) Demand the names of everyone accessing your medical records that made the decision of denial. (You have the right to know)
3) Most of this will result in a decision change very quickly. There are a few reasons to do this.
1) Medical professionals are almost always required to be credentialed in the state where you, the patient, live.
2) Most people making denial decisions are not credentialed that way or are not specialists in advanced fields of medicine.
3) The person or persons who made the denial decisions will be liable for any violations of the Patient Rights Act and they do not want to be
4) The Insurance company doesn't ever want a report sent to the US Office of Civil Rights (OCR.GOV) as a HIPPA violation.
This is not full proof but Someone who worked for decades within the insurance industry wrote most of this life hack and proved that it does work.
Hope it helps someone.
1) Call the insurance company and demand to speak with the Hippa Compliance/privacy officer (They have to have one by law)
2) Demand the names of everyone accessing your medical records that made the decision of denial. (You have the right to know)
3) Most of this will result in a decision change very quickly. There are a few reasons to do this.
1) Medical professionals are almost always required to be credentialed in the state where you, the patient, live.
2) Most people making denial decisions are not credentialed that way or are not specialists in advanced fields of medicine.
3) The person or persons who made the denial decisions will be liable for any violations of the Patient Rights Act and they do not want to be
4) The Insurance company doesn't ever want a report sent to the US Office of Civil Rights (OCR.GOV) as a HIPPA violation.
This is not full proof but Someone who worked for decades within the insurance industry wrote most of this life hack and proved that it does work.
Hope it helps someone.
