Aa
Claim denial
Sorry to post again, but I really need to find this answer today.
Can I force my insurance company to reveal what they based my 'prior medical history" on to deny a claim?
How do I get the insurance company to name the doctor or facility they say diagnosed and treated me outside of hiring an attorney?
Can I force my insurance company to reveal what they based my 'prior medical history" on to deny a claim?
How do I get the insurance company to name the doctor or facility they say diagnosed and treated me outside of hiring an attorney?
I'm sorry; but I have another question. I was looking over the medical records I have and found some discrepancies in them.
Is there any way to get something off of my medical record or doctor's notes? I feel like I should have gone to free medical report [dot] com before visiting my doctor lol
For example: I found in a file that my pcp on 4/27/07 put "PT has a history of diabetes", when in fact, my glucose hasn't ever been over 80 and normal for me is 65-99.
I don't want to to find myself in the same situation as with my current one, fighting what against a dx.
Thanks again :)
Is there any way to get something off of my medical record or doctor's notes? I feel like I should have gone to free medical report [dot] com before visiting my doctor lol
For example: I found in a file that my pcp on 4/27/07 put "PT has a history of diabetes", when in fact, my glucose hasn't ever been over 80 and normal for me is 65-99.
I don't want to to find myself in the same situation as with my current one, fighting what against a dx.
Thanks again :)
"That depends; first on whether or not the insurance carrier can argue that the symptoms you had were severe enough that a prudent person would have sought advice and second on how you stated your complaint and how your provider recorded it."
Thank you again, this is one of my dilemma's. I did seek treatment and went through various testing; which all came back normal and I had a clean bill of health from 2004 until June 2009.
Is there any reason 2 physician's would put their license on the line even suspecting I had a condition; and then treat me with a medication for something that would make that supposed condition worse; to where I would have to have surgery for or possibly die?
As a patient, I went to my physicians trusting their judgement and trusted that they were honest with me. Now; I find out supposedly not 1 but 2 doctors lied, left out facts or just plain overlooked something that could kill me right on the paper in front of them. They both told me nothing was wrong; that I was as healthy as a horse; and prescribed me medications I thought were "safe" for my body which could have killed me.
Who do I believe? The insurer who is trying to get out of a very large hospital claim or my physicans who examined, tested; diagnosed and treated me. This makes me never want to see a physican again and if I have to; since I do have life threatening problems now, can I trust a person of the medical community again.
I'm shaking my head at the insurance industry tactics used and we are so unhappy with this company, we pulled all of our personal and business policies from their offices.
I guess I'll never know who is telling the truth, the ins co refuses to reveal the "prior medical history" they based my denial on, even after a written request.
Thank you again, this is one of my dilemma's. I did seek treatment and went through various testing; which all came back normal and I had a clean bill of health from 2004 until June 2009.
Is there any reason 2 physician's would put their license on the line even suspecting I had a condition; and then treat me with a medication for something that would make that supposed condition worse; to where I would have to have surgery for or possibly die?
As a patient, I went to my physicians trusting their judgement and trusted that they were honest with me. Now; I find out supposedly not 1 but 2 doctors lied, left out facts or just plain overlooked something that could kill me right on the paper in front of them. They both told me nothing was wrong; that I was as healthy as a horse; and prescribed me medications I thought were "safe" for my body which could have killed me.
Who do I believe? The insurer who is trying to get out of a very large hospital claim or my physicans who examined, tested; diagnosed and treated me. This makes me never want to see a physican again and if I have to; since I do have life threatening problems now, can I trust a person of the medical community again.
I'm shaking my head at the insurance industry tactics used and we are so unhappy with this company, we pulled all of our personal and business policies from their offices.
I guess I'll never know who is telling the truth, the ins co refuses to reveal the "prior medical history" they based my denial on, even after a written request.
MEDICAL PROFESSIONAL
Dear Lisa33167,
Regarding your question "even if I said I had experienced problems for years and not been treated or obtained treatment for say heart problems; they can use that information to deny a claim?".
That depends; first on whether or not the insurance carrier can argue that the symptoms you had were severe enough that a prudent person would have sought advice and second on how you stated your complaint and how your provider recorded it.
Sincerely,
Amir Mostafaie
Regarding your question "even if I said I had experienced problems for years and not been treated or obtained treatment for say heart problems; they can use that information to deny a claim?".
That depends; first on whether or not the insurance carrier can argue that the symptoms you had were severe enough that a prudent person would have sought advice and second on how you stated your complaint and how your provider recorded it.
Sincerely,
Amir Mostafaie
Just a warning - be careful what you say to your doctor, NP or nurse -- it can be later used against you to deny a claim even years later; health insurance, life insurance and supplemental health policies. Even if there is no medical history in the time period they state on your policy, they can and will hold it against you later on.
I'm finding out the hard way about this with a problem I've been having with a claim. I posted in the insurance section also, so it was no big surprise when I talked to an attorney this afternoon to hear him say this.
So many of us just want a diagnosis and to be validated something IS wrong...well that can turn around and bite you in the rear...literally LOL
Just something to think about the next time you visit your doctor. I just don't understand what the clauses in policies are for if they are allowed to just turn around and say or use whatever they want to deny claims?
If they would have said over your lifetime, have you experienced any of the following or been treated for any of the following "insert items here" Instead, it's misleading and says "in the past 3 years have you been treated for or been told by a medical professional you have any of the following", I would understand.
How can they get away with this and why even buy any extra policies if they're going to do this?
I'm finding out the hard way about this with a problem I've been having with a claim. I posted in the insurance section also, so it was no big surprise when I talked to an attorney this afternoon to hear him say this.
So many of us just want a diagnosis and to be validated something IS wrong...well that can turn around and bite you in the rear...literally LOL
Just something to think about the next time you visit your doctor. I just don't understand what the clauses in policies are for if they are allowed to just turn around and say or use whatever they want to deny claims?
If they would have said over your lifetime, have you experienced any of the following or been treated for any of the following "insert items here" Instead, it's misleading and says "in the past 3 years have you been treated for or been told by a medical professional you have any of the following", I would understand.
How can they get away with this and why even buy any extra policies if they're going to do this?
thank you kindly :)
I do have one other question - even if I said I had experienced problems for years and not been treated or obtained treatment for say heart problems; they can use that information to deny a claim?
I do have one other question - even if I said I had experienced problems for years and not been treated or obtained treatment for say heart problems; they can use that information to deny a claim?
MEDICAL PROFESSIONAL
Dear Lisa33167,
You mentioned in one of your posts that you went to a weight loss clinic in 2007 & again in 2008. I suggest contacting that clinic ASAP & a) ask them for a copy of your medical records to see if any of the “prior medical history” (as quoted by the carrier) is noted there & b) if any other entity has contacted the clinic requesting/obtaining your med records.
If you are confident that other than the weight loss clinic you have not been seen by any other medical professional, then my guess is Allstate obtained some information from the weight loss clinic. All it takes is for you to tell someone at the clinic something like “Last night when I was lying in bed, I could feel my heart beat…is that normal?” & the person you are consulting will note “the patient has history of palpitation while lying down”.
The other possibility is that after you obtained insurance in April 2009 and started seeing your new doctor you may have advised him that you have been experiencing some of your signs/symptoms for years and that could have played a part in the outcome of your claim as well. So I suggest you obtain your med records from your current doctor (the one that you have been seeing since April) so you can verify that.
If none of the above records show any relevance to the diagnosis alleged by the carrier and you are confident that you have not been seen by any other entity, your best bet is to contact the Florida State Office of Insurance Regulations at 877-693-5236 (this is a special number for complaints) and consult with them how to file a complaint.
Sincerely,
Amir Mostafaie
You mentioned in one of your posts that you went to a weight loss clinic in 2007 & again in 2008. I suggest contacting that clinic ASAP & a) ask them for a copy of your medical records to see if any of the “prior medical history” (as quoted by the carrier) is noted there & b) if any other entity has contacted the clinic requesting/obtaining your med records.
If you are confident that other than the weight loss clinic you have not been seen by any other medical professional, then my guess is Allstate obtained some information from the weight loss clinic. All it takes is for you to tell someone at the clinic something like “Last night when I was lying in bed, I could feel my heart beat…is that normal?” & the person you are consulting will note “the patient has history of palpitation while lying down”.
The other possibility is that after you obtained insurance in April 2009 and started seeing your new doctor you may have advised him that you have been experiencing some of your signs/symptoms for years and that could have played a part in the outcome of your claim as well. So I suggest you obtain your med records from your current doctor (the one that you have been seeing since April) so you can verify that.
If none of the above records show any relevance to the diagnosis alleged by the carrier and you are confident that you have not been seen by any other entity, your best bet is to contact the Florida State Office of Insurance Regulations at 877-693-5236 (this is a special number for complaints) and consult with them how to file a complaint.
Sincerely,
Amir Mostafaie
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