The dude who said too much.

October 20, 2009 5:19 PM

Told my doctor I smoked pot, now I just got a disconcerting letter from my insurance company.

First of all I live in Ohio, in case that matters. I experienced a heart arrhythmia a few months back and went to the ER for it. When meeting with a cardiologist about it afterwards we went through a number of lifestyle questions one of which was do you do any drugs. I answered honestly that yes I do smoke pot once or twice a week.

I asked if this could be a cause of the problem and he said that was highly unlikely and as long as I used in moderation that shouldn't pose any specific problem with my heart.

Now I just got a letter from my insurance company saying before they could process my claims for the incident they need more information.

It says - Diagnosis: History of Cannabis Abuse
and asks for first date of symptoms, treatment and my drivers license number. Where I've sought treatment, when I started, when I quit and how often I used.

I am pretty much shocked, I assumed my statement to the doctor was going to be safe and confidential.

So yeah, anyone else experience this? Am I screwed? Will I get my license revoked? How do I respond to date stopped when I used just a few days ago. Are the insurance folks permitted to share this info with the police? Is this just an attempt to scare me out of filing the potentially expensive claim with them?

Any info or advice would be much appreciated.

posted by anonymous to Health & Fitness (36 answers total)

Write them back a letter saying you have no idea WTF they're talking about. Clearly the doctor misheard you or checked the wrong box or made a typo or something.

I mean, unless someone else was there, it's your word against the doc's.
posted by brain at 5:35 PM on October 20, 2009 [24 favorites]

in accordance with the HIPA Act, the insurance companies can't share this with the police.
posted by Jon_Evil at 5:38 PM on October 20, 2009

Also, I agree with brain's method as a last resort, but if you have the time, call the doctor and ask him what the fuck.

It's possible that he's scamming the insurance companies/you in that whatever treatment he plans to use pays out better for people with history of drug abuse, or that the more expensive option isn't justified to the insurance companies without that history.

Remember that you don't pay the doctor, the insurance company does, so whatever money he can get out of them, he will, but they're going to try and find a way not to have to pay for it.
posted by Jon_Evil at 5:45 PM on October 20, 2009

I would bet that this sent a red flag to the insurance software to send a letter so that they have done their due diligence and maybe someday, just maybe they will get the pleasure of denying you coverage for something else.
posted by ian1977 at 5:46 PM on October 20, 2009 [1 favorite]

From the doctors perspective...he probably just did his job and entered cannabis into your chart...right next to your weight and height and all that...and that info got sent to the insurance company as a matter of course?
posted by ian1977 at 5:48 PM on October 20, 2009

HIPAA (which is a regulation, not an Act) specifically permits a doctor to provide information about an office visit with the insurer which is going to pay for it.

It is common practice for physicians who are seeing a patient to check off several of the preprinted diagnoses on their sheets, so long as there is a hint of history that might support them, with the thought that the more diagnoses that are checked, the more likely the insurance company will pay for the visit. This gets to be reflexive. This might explain why this appears as a "diagnosis" on the record.
posted by megatherium at 5:58 PM on October 20, 2009 [2 favorites]

A couple of things. First, this may not be up to your doctor; it may be something the office staff shared with insurance. Second, the concern here is not so much whether you'll get in trouble - IANAL but I don't think this evidence is admissible in court. The problem would be that if you eventually came down with some kind of condition, the insurance company could suggest that it is a complication of problem x (in your case, cannabis) and then not cover it. I would definitely send a letter to the doctor's office asking for clarification of their policy, and maybe consult a lawyer.
posted by arimathea at 6:06 PM on October 20, 2009

It is legislation, but Act is in the name (hence the last A); but usually people just say HIPPA, and not HIPA Act.
posted by thewalledcity at 6:09 PM on October 20, 2009 [1 favorite]

I agree with brain. No way would I give my health insurance company any information about my supposed "Cannabis Abuse." I probably would not bother following up with the doctor's office but I sure as fuck wouldn't be seeing him again. Jesus Christ.
posted by Maisie at 6:23 PM on October 20, 2009

Did you sign a form allowing the doctor to share your health information with the insurance company in order to seek reimbursement?

I had an appointment with a new doctor today and had to sign such a form, which was buried in all the other paperwork I was filling out. A rather nasty surprise, but what can you do?
posted by charmcityblues at 6:43 PM on October 20, 2009

I had an appointment with a new doctor today and had to sign such a form, which was buried in all the other paperwork I was filling out. A rather nasty surprise, but what can you do?

Unfortunately, nothing. Because if you refuse to sign that form, the insurance company will refuse to pay. And yes, it is legal for them to do that.
posted by Chocolate Pickle at 6:57 PM on October 20, 2009

It is legislation, but Act is in the name (hence the last A); but usually people just say HIPPA, and not HIPA Act.

It's actually HIPAA- Heath Insurance Portability and Accountability Act.

This is not exactly the same situation, but covered entities can only disclose your PHI (protected health information), including drug use, with authorities under very specific circumstances, including if you committed a crime at rehab, they suspected child abuse, or if there was court order or subpoena. Even reporting parolees' drug use is apparently a gray area. And the situations I found were for positive drug tests, not just saying you had used pot. Of course, if they tested you, you would probably be found positive with that type of use.
posted by ishotjr at 7:00 PM on October 20, 2009

Oh and here are my sources: 1 2
posted by ishotjr at 7:02 PM on October 20, 2009

i'm not sure about the legal or insurance issues with this, but i would highly consider delaying any further use until all this gets cleared up. my gut reaction was that, if you do end up denying it, the insurance company may want a piss test to prove that you aren't lying in your denial. i'm also not sure of the legalities of THAT, but it was my first response, so i thought i'd throw it out there.
posted by itsacover at 7:14 PM on October 20, 2009

In a number of instances, U.S. doctors are first of all, mandated reporters, and secondly physicians. It's a charming fiction, perhaps a holdover of simpler times, or a plot device in some television police dramas, that whatever you tell a doctor in the U.S. remains confidential. As you've discovered, confidentiality is non-existent, when insurance is involved, when an employer might be paying for treatment, when a workmen's comp or disability insurer is paying for treatment, or when any other interested party can get a court order to examine you, or your medical records.

Tell a doctor only what the doctor needs to know. Feel free to question the purpose and the expected response of any question a doctor puts to you, before responding. Don't answer any diagnostic question you don't understand, and don't volunteer any information yourself. Authorize only the bare minimum of medical testing. After all, you didn't make the rules or the system, you're just a patient who has to look after their own interests, as everybody else in the health care system does.
posted by paulsc at 7:21 PM on October 20, 2009 [7 favorites]

I live in a non medical marijuana state. When I smoked (which I would still do if the only dealer I knew hadn't moved to freaking Alaska), I told my doctor, because I was able to control a whole host of symptoms without pharmacueticals.

In fact, he asked if I'd quit when my prescription painkiller use climbed. It doesn't show up on my chart (I've read it), and it's never been reported to my insurance...back in the good ol' days when I had some.

The first advice on this thread is dead on. Respond with WTF? Be outraged, demand a retraction from your record. Do. not. admit. anything. Pretend that Johnny Cochran is in the room with you. You admit nothing. Pretend you are a 60 year old Exxon executive with everything to lose, and respond the same way he would. Threaten to lawyer up if you have to.

This is serious. This will count against you just like you were a heroin junkie. Get this off your record. Deny, deny, deny.
posted by Peecabu at 7:33 PM on October 20, 2009 [14 favorites]

HIPAA (which is a regulation, not an Act)

This is Ted Kennedy's surprised face.

It is legislation, but Act is in the name

To be sure, there is an Act HIPAA, but there is also a Privacy Rule which implements HIPAA. The Privacy Rule is part of the CFR.

Finally, there is the problem that individual health providers' application of the privacy rule varies considerably. (I have found this myself to be the case acting as my father's HCPOA.) It's a hugely complex area of medical administration and in a gray area like this you're not going to find many concrete answers. Probably there are doctors who would wink and nod, especially if discreetly asked to be discreet. There are others who will be sticklers for the rules, and still others who are merely covering their own asses.

But in general, yes, insurance companies are actually given great latitude to demand health information about you -- after all, they're paying. It is entirely possible that a drug test is in your future, with the stick being the cancellation (rescission) you will receive if you refuse.
posted by dhartung at 7:59 PM on October 20, 2009

I have to agree with the other posters. DENY. Deny it all the way. Don't even bother calling the doctor. In the future, do not disclose such information to your physician unless it is absolutely necessary to treat something that may be connected with any drug use. There are other things to keep in mind. Anything that goes on your chart, is accessible to insurance companies. That includes your entire medical history. It is a great hunting ground for denying you coverage. I don't know what to do about that, but keep it in mind. Here's one example: if you have a condition, such that there is really no EBM treatment available, like IBS, then why mention it to a physician? He can't treat it anyway, and all it will do is provide ammunition for the insurance company. May as well keep quiet. Pick your battles carefully. These are the sad consequences of our broken healthcare system.
posted by VikingSword at 7:59 PM on October 20, 2009 [3 favorites]

The main problem you have is that now your insurance company will terminate your coverage. Not now, of course. Only when they have to start paying for something big.

If you deny you use cannabis, and they can prove you do, then that's cause to terminate coverage. On the other hand if you admit it, then they may be able to deny your coverage whenever they want.

I would seriously consider changing insurers if you possibly can. Also, doctors.
posted by musofire at 8:25 PM on October 20, 2009 [1 favorite]

Tell your insurance company nothing. This cannot be used against you in court.

And DTMFD!A.
posted by Lutoslawski at 8:57 PM on October 20, 2009

Looking at this from outside the USA, all I can say is that your (the OP's and US society's) whole situation wrt health is completely fucked up.

I'd be changing docs and insurers right quick - they won't cancel you now because they'll want to collect more premiums, but expect to be cancelled if you make a claim.
posted by polyglot at 9:10 PM on October 20, 2009

What brain said. And change doctors. Perhaps call first and see if he will/can somehow retract that info given to the insurance company.

(And if you need to prove that you don't smoke cannabis, it takes generally 2-4 weeks for the THC to flush from your system, depending on your body fat percentage.)
posted by zardoz at 9:12 PM on October 20, 2009

Your doctor misheard.
posted by xammerboy at 9:20 PM on October 20, 2009 [17 favorites]

Wow, another way private medical insurance screws people? This is a new one to me, but it makes sense enough from a follow-the-money perspective.

I have to agree with the above answers: the 'correct' course of action to survive in this sort of health market economy is to lie to your doctors. Bad for population health; necessary for economic survival.

Be sure you tell the doctor why you're leaving him, too. Asshole.
posted by rokusan at 9:33 PM on October 20, 2009 [2 favorites]

Your doctor is sort of a jerk. In the future, query him/her on matters of privacy. In the interim, deny it like hell.
posted by GilloD at 10:07 PM on October 20, 2009

Smoking weed a couple times a week is a completely different animal than cannabis abuse. This makes me wonder if the doctor actually did check the wrong box. I'd call the office and ask for him to personally call me back, and figure out what's going on. Either way, you have pretty solid standing to deny what the insurance company is asserting.
posted by emilyd22222 at 11:00 PM on October 20, 2009

It's been said (conceivably by me) that I have smoked marijuana more or less daily (certainly weekly) for the past 30 + years.

This is utter bullshit. I have never smoked marijuana, certainly not since my undergrad days. And that time the campus cop bustd me? That wasn't even marijuana. It was a clove cigarette.

That's my story and I'm sticking to it.

Honesty is the best policy, except with regard to controlled substances.
posted by philip-random at 11:20 PM on October 20, 2009 [5 favorites]

N'thing that you deny it. And change docs.
posted by pianoboy at 11:30 PM on October 20, 2009

I honestly don't think there is a way that this happened innocently on the part of the doctor. When a health care provider provides information to an insurance company, s/he HAS TO specify diagnoses, not just "oh dude said he smoked some weed sometimes" somehow horrifyingly becomes a Cannabis Abuse diagnosis magically because of mean insurance people. I'm almost 100% sure that your doctor chose to diagnose you with Cannabis Abuse and knew that things would happen to you, and didn't tell you. I would not trust this doctor again.
posted by so_gracefully at 12:31 AM on October 21, 2009 [4 favorites]

Your question asked what to do now. You need to respond to the insurance company's request for more information. But first, it's important to understand that there are 4 players here (at least) so you know what steps your need to take to intervene if you want this off your medical record.

1. The doctor. As mentioned, the doctor may just have noted "cannabis" on the chart. That may have been the extent of his involvement. Do not get angry with the doctor or the office staff. Make another appointment. Bring the letter from the insurance company to the visit to show to the doctor. During the visit calmly explain that he must have misheard you. You used to smoke a little, but you quit months/years ago. Here is the list of codes for cannabis dependence. Point out that prior use does not equal dependence. You were never dependent. Therefore the coding is erroneous. Ask politely that he correct the record with the insurance company.

2. The medical coder. Do you know that there is an entire profession devoted to medical coding? Why? Because it's that complex, that tedious, and the rules are always changing. Depending on the specialty, it's hard to be skilled at coding and the practice of medicine. A professional coder reviews the doctor's notes and figures out how to bill the insurance company so the physician will be paid for his or her time. Usually, there are a bunch of common codes the doc can circle as appropriate, but if that's not enough, and there's the risk of the claim being denied, the coder will scour the chart for more diagnostic codes to include in the claim. (By the way, the work of these professionals is one of the many unseen costs of getting health care in this country.)

3. The insurance company. When you first see a physician, the paperwork you are asked to sign includes an agreement that the doctor can share confidential information with the insurance company. You're unlikely to get care unless you sign this since it's the only way the doctor can get paid. The insurance companies use the information for their purposes. They are in the business of maximizing profit by assessing risk. Although they're asking for information from you, in order to get the diagnosis off your medical record, the insurance company must hear from the doctor or someone on his staff making a call on his behalf. The doc needs to amend the chart and send a copy of his notes to the insurance company. This may work instead of sending a letter. But in order to get this addressed someone on the doctor's staff will have to spend at least an hour dealing with the insurance company. Be very nice to the staff. A plate of cookies might be in order if you can do it without seeming disingenuous.

As I said, you need to respond to the insurance company's request for information. Write them a letter explaining that a mistake has been made and that you are working to correct it with the doctor's office. cc the doctor. Keep it simple, firm and clear.

4. You, the patient. Be nice. Be polite. Have your shit together. Be patient with the process but pursue this until the record is corrected.

If you don't get anywhere on your own, you might have to hire a lawyer.
posted by pocket_of_droplets at 6:13 AM on October 21, 2009 [14 favorites]

Mod note: comments removed - do not turn this into a debate about american health care or "what were you expecting??" thank you
posted by jessamyn (staff) at 8:38 AM on October 21, 2009

In Pennsylvania, people have lost their driver's licenses for telling doctors that they drink beer after work. I don't expect that this is the sort of thing that would improve with a government-run health care program.

Nevertheless, I think your best bet is to follow the advice you've already received: The dotor misheard you.
posted by DWRoelands at 9:58 AM on October 21, 2009

I have no idea why your physician dx your marijuana use as abuse--it is interesting to listen to what patients (and Drs) think they said during an interview versus what they actually said. And as you know that is vastly different than what was heard. Talk to your physician about the marijuana--my guess there is nothing nefarious in his/her diagnosis. A practicing cardiologist is not going to run up a bill by (mis)diagnosing cannabis abuse. It is good that you disclosed this as it may pay off in the future. With holding info. from a physician or health insurer is an excellent way to get poor trteatment or claims denied in the future. I swear there is a subtle streak of paranoia on Ask MeFI when it comes to drug use. While information of this kind can be misused--by a variety of interests--it is not nearly as interesting to them as it is to you. As you probably know, insurance regular pays for a variety of abuses/addictions--I know because we routinely got paid by many many insurance companies and other payors for treating it. When you don't get paid is when related benefits have run out, the patient has deliberately withheld information on applications or for a variety of coding/clerical problems. I hope you get this clarified
posted by rmhsinc at 10:03 AM on October 21, 2009

I don't think rmhsinc has it right. The insurance company is asking you to be complicit in denying you coverage, now or in the future. It happens all the time and has nothing to do with drugs or paranoia. It has to do with the business of health care. Insurance companies are in business to make money, not pay it out. Sure, they might pay for rehab now, but then decline to pay for an expensive treatment in the future that they can blame on a pre-existing condition.

The majority of the advice here is spot on: Go to your doctor and politely request that he amend your chart. There's been some kind of misunderstanding. You've never had a History of Cannabis Abuse and are willing to sue someone who says you have.
posted by maniactown at 11:24 AM on October 21, 2009

A quick side-comment about whether this can be used in court, the answer is "it depends." In some instances it will be admissible, in others not.
posted by craven_morhead at 11:41 AM on October 21, 2009

First get it cleared up with your physician as whether or not he/she Dx you with cannabis abuse--if so, why. If the physician thinks this is an accurate dx you can anonymously call your insurer (with info about your plan) and directly ask them the implications (do not call from home or cell phone). Regardless, do not mislead either the physician or the insurance company re: any pertinent medical information. In most instances in Ohio, if you have a group plan, you can not be denied care for a pre-existing condition ( check your plan conditions) and if you go into another group you usually can not be denied treatment for a previous condition except for pregnancy and other specific exceptions. Individual plans vary but after a waiting period most preexisting conditions are covered. One way to increase the probability of denial is to not disclose information when requested or at the time of application, There are thousands, and I mean thousands, of people in Ohio getting out- patient treatment for substance abuse but more importantly there are thousands more getting an incredible amount general medical services with active or past substance abuse. Hopefully these will all become non issues when ( I Hope) healthcare reform is passed.
posted by rmhsinc at 3:20 PM on October 21, 2009