Incorrect medical information released

undefinedWhat is the name of your state? New York
In April I was in the hospital and ended up being out of work for two weeks. (I am self employed). My insurance company pays benefits for emergency room visit and in hospital stay and out of work benefits. I have been waiting over two months. Just received letter from insurance comppany canceling my policy and not paying me, based on medical information they received.

Upon request from my insurance company, a cardiologists' office released medical information on me ( yes I signned a medical release). The problem is they released SOMEONE ELSE'S medical information under my name. This information erroroneously reported me having a heart condition dating back to 2001. The information they provided caused the insurance company to send me a letter just about accusing me of fraud and having a prior condition, and canceling my policy and not paying me for out of work. (inturn, I ended up in court for being late on my rent and being charged $890 in attorney fees) (this insurance money was to pay my rent while out of work..
Isnt this negligence and can I recoop anything? Does the HIPAA law protect from this kind of negligence?

fmhnails
My honest answer is I don't know the answers to your questions and here's why (other than my not being an attorney)...

You signed permission for a cardiologist to release information regarding your health and you don't tell us why you had seen a cardiologist at all. It is possible that even the correct information would have yielded the same result and that would mean no negligence and no opportunity to file a suit against your insurance company.

HIPPA, if violated in this incident, would apply to the person whose records were incorrectly provided to your insurance company. Your HIPPA rights weren't violated.

If your actual health would not have precluded eligibility for this policy and if your application for insurance is factual and without omission or deception AND if the insurance company will not cooperate by accepting accurate medical records and paying benefits, then you need to consult with an insurance attorney or contact your state's office of Insurance Commission.

EC

thanks and more info

Thanks for your reply...

First, while out of town I went to the emergency room for heart palpitations and high heart rate. The cardiologist admitted me observations and tests.
NO, I have NEVER had these symptoms nor been treated for them and THANKFULLY have not had a reoccurance. The insurance company has accepted the corrected ifnfo and are cooperating. My question is... can the cardiologist office be liable for occurance of events (regarding my attorney fees for late rent situation) due to their negligence and errors?
thanks again

fmhnails
Much depends on the insurance laws of your state and the terms of your policy.

For the benefits you described, most insurance claims take several months to process and initiate payment. If you have been waiting for only two months and your rent became past due at such a stage of late-payment that you ended up in court, then it raises the additional question of who is to blame for the late payments.

The medical records--in which way were the records erroneous? Was your name on the records and someone else's information documented as being yours or were the records appropriately titled and containing correct information for that person? If the former is true, then I think the cardiologist is responsible; if the latter is true, then the insurance company had the responsibility to make sure they were reading and applying the correct person's information.

EC

ellencee said:

For the benefits you described, most insurance claims take several months to process and initiate payment.
EC

Click to expand...

I hate to dispute you ellence, but I am a supervisor of hospital registration and billing. Industry standard, as driven by Medicare and HCPCS dictates that insurance claims should be received processed and either denied or paid within a 45 day period...Most hospitals generate itemized bills within 5-10 days for facility charges, ancillary charges take longer, i.e. the radiologist that read an x-ray; it sounds as though his insurance originally denied the claim and requested further documentation, received the incorrect patient information, denied the claim based on the incorrect patient info and cancelled the policy due to a pre-existing condition. The OP should have been notified within a 30 day period by E.O.B, (explanation of benefits ), what was taking place with his claim. Although they state "THIS IS NOT A BILL" it is an insurance statement and should be reviewed carefully. The OP should contact his former insurance company administrator and file a level 1 grievance/appeal and follow the insurance's process to have benefits reinstated and policy benefits paid.

truly
This is not a hospital billing issue or a medical provider billing issue. This is a mixed-benefit claim, part of which is for payment of wages lost due to illness.

As I stated, I am not familiar enough with NY insurance law to state with any degree of certainty how NY insurance law regulates provision of benefits in these circumstances.

The OP is asking if the cardiologist can be held responsibile for paying his attorney's fees when he had to appear in court for past due rent during the interim of when he filed for insurance benefit payment and the denial of benefits. So far, I can not determine if the wrong patient's file was sent, or if the OP's records contain another patient's information.

Regardless of the answer to that question/scenario, I believe the insurance provider had the duty to make sure information being used in a determination is the correct information.

Somewhere in the OP's policy and declarations, a method for resolution of any dispute is provided. Most likely, this is where the OP needs to start in resolving these issues.

Thanks,
EC

Concerned with MD actions not insurance co

Thanks again for continued responses. I appreciate all help.
Regarding the medical records released.My name was on records and someone elses medical history was documented as being mine. Since then the information has been corrected. My concern is with the MD office liablility not the insurance company. The insurance company supposedly is "Processing" my claim. Any wesite known for NY state insurance laws and information?
Thanks again