Q: Is there a claim when an unauthorized person writes to my spine doctor and my insurance company causing medical denial?
This is a very strange situation; I have been seeing a spine doctor for 8 years. My doctor wrote a couple scripts for medical equipment and letters to support their need. My insurance company sent letter with more questions to the doctor. I then contacted the medical records dept. of my doctors office to request this letter of questions so I can see what is needed to be known for approval.
The medical records clerk sent me email stating they cannot send my records to me. I told her these are my records and cannot be held.
Finaly the clerk sent this letter to me and WITH OUT MY APPROVAL OR KNOWLEDGE sent a letter to insurance adjuster stating the "doctor refused to answer the questions". MY adjuster then told me that she got a letter from my "doctor" and as a result of this letter will NO LONGER CONSIDER THIS EQUIPMENT!
I DO NOT HAVE A CURRENT HIPPA AGREEMENT WITH MY INSURANCE COMPANY!
Can I sue the medical records clerk and medical office? Do I have ANY LEGAL RECOURSE?
A:
It's difficult to offer an answer without knowing what the letter contained and what the grounds for the denial was (medical necessity?). You could consult with a Michigan attorney to learn if they feel it would be cost-effective to pursue. Good luck
Tim Akpinar
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