What is the name of your state? Texas.
I am not sure if my situation is a medical malpractice case, but I have questions about what I need to do.
A couple of weeks ago, I went to see my PCP for a prescription refill. When I was told I had a balance from a previous visit, I called my Insurance Company. While the Woman with my insurance company was going over my recent Dr. visits, she said the diagnosis could be the problem, and she said what the diagnosis was. I had to ask her to repeat it, not because I don't know what it is, but because I was shocked. My Dr. has been billing my insurance with a diagnosis of COPD!!!! I have NEVER been tested for COPD nor told I was ever diagnosed with it. Both the Dr and his Nurse insisted and said the diagnosis came from my Medical records at a certain Hospital 5 years ago. So, I ordered all of my medical records from this hospital and nowhere do my records indicate a test or diagnosis of this disease. I called my Drs office back and the Nurse now claims "The Dr. himself diagnosed you with COPD years ago, and he can send you for a test if you want". I asked, so what about these Medical records you said that showed I have this disease? She studders and comes up with a completely different date 3 years earlier, same Hospital. I almost immediately remembered that the "new" date she gave me was when I had pre-op work done a few days before hand surgery! And they claim I was diagnosed with COPD from that.
I don't believe my Dr is going to amend my medical records because he's insisting he's right and his Nurse is going to say and do whatever he says.
What if anything can I do? I especially need to have this false information removed so I don't get canceled by my insurance company and be deemed to be uninsurable OR have a monthly premiums so high, I can't afford it.
I think this Dr. definitely needs to be reported to the State Medical Board but my 1st concern is what is now in my medical records. I'm so mad Why did he do this? Because diagnoseses determines how much a Provider gets paid by the Insurance Company. Example: I had an ear infection a few months ago and the diagnosis was..you guessed it.
I am not sure if my situation is a medical malpractice case, but I have questions about what I need to do.
A couple of weeks ago, I went to see my PCP for a prescription refill. When I was told I had a balance from a previous visit, I called my Insurance Company. While the Woman with my insurance company was going over my recent Dr. visits, she said the diagnosis could be the problem, and she said what the diagnosis was. I had to ask her to repeat it, not because I don't know what it is, but because I was shocked. My Dr. has been billing my insurance with a diagnosis of COPD!!!! I have NEVER been tested for COPD nor told I was ever diagnosed with it. Both the Dr and his Nurse insisted and said the diagnosis came from my Medical records at a certain Hospital 5 years ago. So, I ordered all of my medical records from this hospital and nowhere do my records indicate a test or diagnosis of this disease. I called my Drs office back and the Nurse now claims "The Dr. himself diagnosed you with COPD years ago, and he can send you for a test if you want". I asked, so what about these Medical records you said that showed I have this disease? She studders and comes up with a completely different date 3 years earlier, same Hospital. I almost immediately remembered that the "new" date she gave me was when I had pre-op work done a few days before hand surgery! And they claim I was diagnosed with COPD from that.
I don't believe my Dr is going to amend my medical records because he's insisting he's right and his Nurse is going to say and do whatever he says.
What if anything can I do? I especially need to have this false information removed so I don't get canceled by my insurance company and be deemed to be uninsurable OR have a monthly premiums so high, I can't afford it.
I think this Dr. definitely needs to be reported to the State Medical Board but my 1st concern is what is now in my medical records. I'm so mad Why did he do this? Because diagnoseses determines how much a Provider gets paid by the Insurance Company. Example: I had an ear infection a few months ago and the diagnosis was..you guessed it.
