Doctor won't give me info to file w/ insurance.

September 26, 2007 3:30 PM

What can I do if my doctor will not give me the information I need to file with my insurance?

I used the telecounseling services of a reputable psychotherapist in a different state for about 8 months. At the preliminary session I made a point to inquire about insurance. The counselor told me that while he doesn't file for his patients he had "no problem" giving me the information to do so myself. With that I went a head with the counseling. After a few months my wife and I solicited the counselor by email for the to-date information that we may file with the insurance. Our requests were initially ignored, then pacified over the next few months. After we got pretty firm about the matter we received a seemingly sincere apology by the counselor wherein he took full responsibility for neglecting to follow through on the matter (incidentally during our last counseling session). We got the said information in the mail a couple weeks later. A few weeks after that we decided to crunch the numbers, whereupon we discovered that there was a huge discrepancy between the amount the counselor billed us, and the information he gave us to bill the insurance. Only about half of the sessions were included in the insurance information (which translates to about $1000 I could--but won't be able to--get reimbursed from my insurance. I promptly wrote a firm yet polite email to the counselor (apologizing for bothering him with this again) and explained the discrepancy...complete with a detailed itemization. That was almost three weeks ago and we've heard nothing. What should I do? Do patients have a legal right to correct information with which to bill insurance?

posted by keith0718 to health & fitness (10 comments total)

Of course you have the right to all of your medical information.

Have you reminded the therapist of his legal obligations to you under federal HIPAA law? And that he really should be obeying federal law in a responsible and timely manner?

And stop apologizing to him for supposedly bothering him with all this. You have every right to the complete records. No need to apologize for wanting what's yours.
posted by Thorzdad at 3:38 PM on September 26, 2007

Thorzdad is correct. Not only that, if he fails to give you those records in a timely fashion, you have the right to complain to the Secretary of Health and Human Services.
posted by ilsa at 4:07 PM on September 26, 2007

As a side note--counselors/psychotherapists have different disclosures. For instance, they do not have to release therapy notes to the patient if there is a chance it could harm the patient. In fact, most won't do it.

Billing information is another story . . . Contact his office by phone or by snail mail. If by snail mail, send it certified. Be firm, yet polite.
posted by 6:1 at 4:15 PM on September 26, 2007

See this, scroll down to "psychotherapy"

http://www.healthprivacy.org/usr_doc/RighttoAcces.pdf
posted by 6:1 at 4:23 PM on September 26, 2007

I don't think sending an email and waiting is really sufficient to impress upon someone that your request is important... if you haven't phoned, then do that.
posted by loiseau at 4:35 PM on September 26, 2007

Why would he be balking at this reasonable, eminently easily satisfiable request?

Only one thing occurs to me-- he didn't declare this income on his taxes.
posted by jamjam at 4:39 PM on September 26, 2007

I agree with loiseau that you need to call this guy to straighten this out. And if he doesn't respond to your voicemails, call back. 1-2 business days is a sufficient time to wait for a response before following up again (unless he has a message indicating that he's out of the office and will not return until such-and-such a date).

Don't worry about being rude. He's the one being rude by ignoring your inquiries about a very legitimate concern. He is supposed to be a professional.

While the ball is technically in your court, since the outcome of this scenario benefits you and not him, you're going to have to keep hitting balls across the net until he sends one back. It's not being a nag, it's just personal responsibility.

You can never trust people to do what they're supposed to do. It's always better to take action than to stress out about someone ignoring you.
posted by tastybrains at 4:43 PM on September 26, 2007

The first thing that came to mind is what jamjam said.
posted by Krrrlson at 5:25 PM on September 26, 2007

Start sending reiterating your request for for accurate records.

For your own records/sanity, reconstruct a timeline to the best of your ability detailing all previous conversations and correspondence on this issue, and keep it updated.

He gets away with this crap because a lot of people don't report therapy to their insurance or their insurance doesn't cover therapy. I'm sure, from what you've said, that he will have some nicey-nice misunderstanding story...funny how he didn't accidentally bill you for less than the full amount, though, huh?
posted by desuetude at 8:21 PM on September 26, 2007

Thanks everybody for the great advice and counsel!
posted by keith0718 at 8:38 PM on September 26, 2007