Excellent post and responses! Here is another angle on a similar situation: I did not land this client, however a gentleman contacted me with insurance reimbursement issues for his wife who has recently suffered with multiple health issues. In this case, he carries the insurance so my thought was he would be the client, even though the issues…[Read more]

I have a friend who I met through another friend. She is only 45y/o but has multiple medical issues. She elected me as her DPOA because her Fiance’, (soon to be husband), and her mother, who is an elderly retired nursing home RN, would admittedly both have difficulty giving direction for end of life care for her, despite an Advanced Directive.…[Read more]

This is fantastic! I hope other states do their own investigations also.

Thanks for sending this out, Nancy! I am Looking forward to chatting with you all again, there is so much to chat about 🙂

Steph

Also, keep in mind that the patient (AKA You since you are representing the patient) has a right to access their medical record, according to the Patient Bill of Rights. I recommend researching to see if there are state specific rights.

I wish you luck!!

Io – are they billing insurance or Medicare? They may be “off the grid” but if they are receiving payments on your client’s behalf, then there are records of what they billed.

The skeptic in me thinks your story suggests there is fraud going on… That is another reason medical records “aren’t available.” If the only records they can produce are…[Read more]

Melanie – thank you for this!

I don’t know of any virtual send-offs, but I can tell you that many of us will be getting together at ICOPA. I would just love to meet so many folks I’ve gotten to know over the years but have never met in person. 🙂 Check it out: http://www.ICOPAConference.com

During the Forums today we’ll be talking about my future…[Read more]

Excellent discussion. Very helpful.

I suspect that (at least I hope) that there are records as every provider is required to document each and every encounter with their patients. I think they may be just being difficult as opposed to neglectful, as especially with infusion, the med, dosage, and patient reaction needs to be documented not only for proper record keeping, but also…[Read more]

Thank you Jennifer and Melanie, this is all very helpful. This is an independent hematologist office that also has a small infusion clinic to provide treatments. I have the suspicion that they are simply refusing to give us the records, which is a different matter. I will confirm if this is true.

If she is indeed so much off the grid that she…[Read more]

I agree with Melanie!!!!

Medical records are essential for the continuity of care. Without accurate medical records to reflect this, the provider is running a huge risk in so many areas.

My suggestion is to bring it to the insurance companies attention, especially if they are in-network, because accurate record keeping is often a requirement…[Read more]

I recommend calling the insurance company directly about the matter because this is essentially what the provider’s office will do. They may end up getting the provider on the phone too but it sounds like it’s the insurance companies error since providers are often just doing what is indicated on the EOB/electronic remit. As mentioned above, this…[Read more]

There is no update on this. The insurance company is allowing the charge or the contract rate, whichever is higher. This resulted in a slighter higher coinsurance balance, but there was a billing error for the number of tests which the client is following up on. They are not contesting the higher allowable.