I’ve written elsewhere about medical insurance being basically a rip-off. Since I currently get most of my healthcare through the VA Medical Center, I don’t generally have to deal with that. I still maintain group health insurance through my job, since there is no telling when the government will push me out of the VA system (after all, our government has made promises that it has no way of keeping).
I recently heard about a hack that might be useful to anyone who has been denied for coverage of a test or treatment that your doctor ordered. I’m not 100% sure that this would work, but having seen the insurance business (rip-off) from the inside, it certainly seems feasible.
- First, you get the letter that the insurance company sent to deny your claim.
- Call the insurance company, and ask for the HIPAA Compliance/Privacy Officer. Federal law requires every insurance company to have one, so if they stall on that, just tell them that you will report that violation.
- Once you get the designated HIPAA lackey, ask for the names and credentials of every person who accessed your records in order to process that denial. Again, you are entitled to that information by Federal law.
At this point, there is a very high probability that the denial will be reversed. The reason for that is that the insurance company does not want you to know that the decision was made by minimum-wage flunkees who simply did a search for buzzwords. Even in the rare case that the denial was made by somebody with medical training, it is very unlikely that the person making the denial was a board-certified doctor in the specialty required to be qualified to make that denial.
Any refusal to provide the requested information can be reported first to your state insurance regulators, and then to the US Office of Civil Rights, Health Information Privacy section.