falsified medical records

[ama24a]

What is the name of your state? oklahoma

I'm in the process of getting individual health insurance, I was denied because of a few things written in my records, once the letter came back as to why I found out that the doctor wrote that I have GERD which ive never been seen for or treated by anyone. The date that it was written was the day I went in for a sinus infection, I was asked what I was taking so something could be perscribed, I take over the counter acid pills cause due to foods sometimes it bothers me but never been diagnosed or treated so now thats in my medical records and that was a reason why my insurance denied me, what can I do about this? How can I get that taken off my records?

 

[lealea1005]

What is the name of your state? oklahoma

I'm in the process of getting individual health insurance, I was denied because of a few things written in my records, once the letter came back as to why I found out that the doctor wrote that I have GERD which ive never been seen for or treated by anyone. The date that it was written was the day I went in for a sinus infection, I was asked what I was taking so something could be perscribed, I take over the counter acid pills cause due to foods sometimes it bothers me but never been diagnosed or treated so now thats in my medical records and that was a reason why my insurance denied me, what can I do about this? How can I get that taken off my records?

Your records were not falsified. Your Doctor documented the medications (including OTC) you were taking. One of them was an "acid pill" which are taken for acid reflux/GERD/indigestion.

You cannot get the diagnosis taken out of your medical record. You CAN ask that a concise
statement of the reason you disagree with his diagnosis be placed, as an addendum, into your medical record.

The insurance company may change their determination, but don't hold your breath.

 

[ama24a]

thanks but I have tried that, letters have been written, the first letter they wrote was written on a prescription pad which was very unprofessional and the insurance said that was unacceptable and I went back and had them do it again, this letter was more professional but didn't clarify or explain anything, it didn't seem that important to them. So for future reference for insurance I can have them write a statement in my records explaining this and why I disagree about it being in there? Your right about don't hold your breath with the insurance reconsidering, I've been denied 4 times now, so I'm finished there isn't anything else I can do, I guess my best bet is don't tell the doctor anything you don't want written in your medical records. I do plan on finding a different family doctor.

I do have another question regarding this same office, I went in for a follow up of an infection I had not had my menses yet but I had told them I'm not regular and that I took a pregnancy test before I came into there office because without insurance those are very expensive, she said okay then without my consent and knowledge they went and took a pregnancy test and then charged me $50.00 for it, what can I do about that? I dont think I should have to pay for it cause I didn't give my consent, they only had my consent to retest my urine for a UTI.

Thank You
Angie

 

[lealea1005]

thanks but I have tried that, letters have been written, the first letter they wrote was written on a prescription pad which was very unprofessional and the insurance said that was unacceptable and I went back and had them do it again, this letter was more professional but didn't clarify or explain anything, it didn't seem that important to them. So for future reference for insurance I can have them write a statement in my records explaining this and why I disagree about it being in there? Your right about don't hold your breath with the insurance reconsidering, I've been denied 4 times now, so I'm finished there isn't anything else I can do, I guess my best bet is don't tell the doctor anything you don't want written in your medical records. I do plan on finding a different family doctor.

I do have another question regarding this same office, I went in for a follow up of an infection I had not had my menses yet but I had told them I'm not regular and that I took a pregnancy test before I came into there office because without insurance those are very expensive, she said okay then without my consent and knowledge they went and took a pregnancy test and then charged me $50.00 for it, what can I do about that? I dont think I should have to pay for it cause I didn't give my consent, they only had my consent to retest my urine for a UTI.

Thank You
Angie

They, appropriately, did their own pregnancy test. You stated your menses was irregular. If you were going to receive medication for your infection that could be harmful to the fetus or a pregnancy, they are obliged to have their own documentation of a negative result.

As for your medical record....YOU write the statement and request that it be made part of your medical record.

BTW, writing something on a Rx sheet if not unprofessional and accepted as proof it came from the Physician by most insurance companies.

 

[LAWMED]

You were denied because of GERD????? WTF?!?!

 

[lealea1005]

You were denied because of GERD????? WTF?!?!

Lawmed, I've seen people denied for GERD...and ...(believe it or not)...we had a patient denied for sinusitis!!!!

 

[LAWMED]

Wow...guess that's a lesson...never say you take ANY OTC meds!

 

[NEOhioChick]

Wow...guess that's a lesson...never say you take ANY OTC meds!

No kidding, if you say you are taking aspirin they would deny you because the doctor would have written you have heart problems! I don't understand how an insurance company can get around all the privacy laws and HIPPA and be able to see what is in your medical charts. I have stuff in my past that I do not want doctors to know because I would be treated differently.

 

[ecmst12]

Um....you GIVE your doctors your medical records, or they can get them without your explicit authorization if it is necessary to treat you. You should always be completely honest with your doctor. If it makes them act differently towards you, then you should get a new doctor, but in order to treat you correctly and effectively, they need to know your complete and correct medical history!

 

[lealea1005]

No kidding, if you say you are taking aspirin they would deny you because the doctor would have written you have heart problems! I don't understand how an insurance company can get around all the privacy laws and HIPPA and be able to see what is in your medical charts. I have stuff in my past that I do not want doctors to know because I would be treated differently.

Foolish and possibly dangerous.

 

[lya]

Lawmed, I've seen people denied for GERD...and ...(believe it or not)...we had a patient denied for sinusitis!!!!

lealea, For the sake of continuity, I'm using your post in my reply.

I do not believe the physician should have made a diagnosis of GERD based on the patient's statements that he/she takes OTC meds for heartburn. Subjective information alone does not provide the necessary basis for a diagnosis.

I believe the physician should remove the diagnosis and state only what the patient said.

If the physician wants to diagnose GERD, then do the workup and make the diagnosis after the objective information is available.

If the physician failed to follow required diagnostic procedure and the poster was denied insurance only because the physician used subjective information as a diagnosis, I think the poster should be able to sue the physician if the poster is unable to obtain insurance one the medical records are made accurate.

 

[ecmst12]

I don't think the doctor diagnosed her with GERD, I think it was more like he wrote a note in her chart that she was taking OTC meds for GERD. I think it's ridiculous that an insurance plan would deny her for something stupid like that, but nothing prevents them from doing so.

 

[k needs help]

I agree with lya regarding a work up and clear evidence of gerd. To chart you are taking anti-acids is not a dx by a doctor. If you were scoped and there was evidence, yes it is valid. If just stating you take otc anti-acids and the amount of sales of Tums and other anti-acids in the United States more than likely 85% or more of people would be denided health insurace based on this. Be careful on whos advise and opinion you consider based on reading the other replies to your question.

 

[ecmst12]

A private health insurance plan can deny anyone they want, for any reason they want.

 

[ama24a]

I'm sorry but I disagree it is very unprofessional to write on an rx pad and I'm very aware that meds can harm a fetus, I have changed doctors and will no longer use that office.