handwritten medical records hard to read?

January 9, 2014 10:20 AM

After experiencing an extremely nasty psychiatrist I just need to get my medical records per the request to my insurance to get partial reimbursement for the claim.

And after half years back and force phone calls and messages and mails emails, finally I got a copy of crappy handwritten "notes". I don't know if it can be called "medical records" because it's really some scribble! And from my rough reading it's full of mistakes, misinterpretations, wrong private details and I also noticed it was tailored to cut off some content and emphasis some other, on purpose obviously. And the final diagnosis is ridiculously stigmatizing which is why I left this practice and moved on to some better real doctors and found out my real medical problem. This is just by rough reading, the handwriting is very hard to read that I can't recognize all the bullshit so to possibly correct them. And the nasty doctor told me he can't spend any more time on this when I asked him.

What should I do now? I need to submit medical records for insurance claim to reimburse the pretty penny wasted on this d!@#@$#bag, but I'm so sick and tired of dealing with this A#$#@%!shole. Can I just suck it up, if it doesn't matter too much to submit this shit "notes" full of misinformation and personal details to my insurance? I have newer claims with newer diagnosis after this whole shit of misdiagnosis. What's the worst consequence?

Thanks very much.

posted by pack2themoon to Health & Fitness (19 answers total)

Wouldn't your medical records be a log of the dates of your office visits, what you paid for them and any coding done for medical reimbursements?

As for the "notes" I'm not sure that's what your insurance needs. Before sending that in, call your insurance and explain what it is that you have. Ask them for details of what they actually need.

Perhaps you can subpeana your records, and be specific about what you need.

That way, you're not interacting with this yutz.
posted by Ruthless Bunny at 10:26 AM on January 9, 2014 [3 favorites]

A couple of items:

1. Is your insurance company really asking for your full medical records to process the claim? In my experience, they need to see a very detailed, itemized invoice that includes the treatment code, date of service, diagnosis code, and a bunch of other data points, but I've never been asked to provide further details such as doctor's notes. I think there is a chance they don't need/want the psychiatrist's notes at all. Might be worth a call to sort that out?

2. Are you employed? If so, do you have access to a health advocacy program? My employer and many others offer a service to employees that basically acts as a middle man between doctors, insurance, etc., so you don't have to deal with those folks if you don't want to. Dealing with an asshole psychiatrist on administrivia seems like a good opportunity to use them if you have access to them.
posted by schroedingersgirl at 10:27 AM on January 9, 2014 [1 favorite]

You may also have better luck explaining this to someone at your insurance company, to see if they can contact this office and "demand" some of the info that Ruthless Bunny and schroedingersgirl have mentioned above.

Sometimes, medical offices respond better to insurance companies' demands than a patient's demands. I know that sucks, but it is the truth.
posted by kuanes at 10:29 AM on January 9, 2014

Response by poster: Thank you guys, I've done all that you mentioned and I totally understand what my insurance are looking for: initial date of treatment, treatment plans, psychotherapy records, etc to justify the claimed codes the doctor submitted(both office visit and psychotherapy for each session).

I had the insurance company to contact the doctor nonstop every few weeks and the representatives talked to the doctor. BUT the asshole keeps being nasty, we can do nothing about it but waiting and calling. AND he finally showed something, and it's that shit. At this point I'm exhausted and I don't expect this d@$#@chbag can even provide anything decent, (he even asks me for $100 to write a separate letter). I'm really done with this shit and don't want to care any more. So I just want to know what's the worst consequence if I submit this?

Thanks.
posted by pack2themoon at 10:42 AM on January 9, 2014

So I just want to know what's the worst consequence if I submit this?

Hard to say for sure, but I would guess either (a) the insurance company responds poorly to this psychiatrist's original diagnosis and needs more proof from your current psychiatrist regarding your correct/new diagnosis, or (b) they refuse to accept the handwritten notes and more back-and-forth ensues.

IANYIP, IANAIP (I am not your/an insurance provider) so take this all with a grain of salt. My suggestion is to submit what you have and get the ball rolling now. The sooner you do that, the sooner you'll find out what if anything needs correcting, and the sooner you can make those corrections and get reimbursed.
posted by schroedingersgirl at 10:51 AM on January 9, 2014

I had a doctor do this to me and I submitted their garbage and they, not me, got in trouble with the insurance company.
posted by melissam at 11:11 AM on January 9, 2014 [1 favorite]

Oh also I submitted the conflicting and correct diagnosis from two other doctors with the paperwork. I also talked with my insurance company on the phone before I submitted it and told them that I had seen a doctor who had given me a misdiagnosis that conflicted with what other doctors said and had prescribed inappropriate (and in my case potentially dangerous) treatment. I probably also should have talked to a lawyer, but at the time I didn't have the money.
posted by melissam at 11:17 AM on January 9, 2014

Response by poster: Ok let me be specific into details:
I was finally diagnosed with Lyme disease (late stage, neuro-Lyme, still not CDC positive, but enough reactive bands for LLMDs), before that I have a lot of neuro-Lyme symptoms and I was struggling seeking help from psychologist and psychiatrist because I scored 99.7% on all ADD scales.
I refused to accept that what I have is depression and everything is in my brain. This shrink is especially nasty, when I gradually opened up and stupidly discussed with him I suspect I have this mysterious disease, he wrote on his note I have a lot of psychiatric disorders including paranoia, major depression, psychosis, delusion....wtf!!!!

My concern is basically on: will these shit psychiatric diagnosis affect my subsequent insurance claims with LLMD for my lyme disease treatment? I don't want my Lyme disease doctor claims be declined because they think I am psychiatrically disordered. My ongoing Lyme treatment is very expensive I am depending on the partial coverage from my insurance.
posted by pack2themoon at 11:18 AM on January 9, 2014

Response by poster: melissam, glad to hear similar experience. May I ask how they got in trouble and not you? I paid the psychiatrist in cash fully already and if insurance has any problem with the claims(I submitted myself) it's my loss not the jerk's.
posted by pack2themoon at 11:23 AM on January 9, 2014

The insurance company asked the doctor for the appropriate paperwork and to justify their treatment, and the doctor never submitted it.
posted by melissam at 11:26 AM on January 9, 2014

I would just submit the notes.

I think it's important to remember that handwritten shrink notes are just that, notes. He might have written down words like "paranoia, major depression etc." to note to himself that he should consider those diagnoses for you. The notes were probably not actually meant as diagnoses.

I hope that helps you feel better about this.
posted by sparklemotion at 11:42 AM on January 9, 2014

Response by poster: Thanks sparklemotion, I don't care what the shrink thinks about me, he is wrong anyway and lab tests had already proved this.
I care what the insurance examiner thinks about these, they are actually written in "Dx:" part in the charts.
posted by pack2themoon at 11:50 AM on January 9, 2014

You should contact your state medical board to find out if your doctor is violating any record retention/availability requirements and, if so, to file a complaint.
posted by melissasaurus at 12:18 PM on January 9, 2014 [3 favorites]

-Submit a written request via certified mail (with return receipt!) for a certified copy of your complete chart, from Time Period A to Time Period B. Don't rely on phone calls or e-mails for this, and be very specific about the time period. Even if you want the whole chart, specify the time period you saw the doctor. If you're not sure of the exact dates, then date it January 1, YEAR OF FIRST VISIT, to December 31, YEAR OF FINAL VISIT. I don't know why this works better, but it does. BTW, it should only take ~30 days for an office to complete a request for medical records, and you're asking for a certified copy because the recordskeeper has to sign a sworn affidavit that the records being sent to you are complete, true, and accurate.

-After that, if you get the same couple of pages with scribbles, and you know for sure that you filled out questionnaires for every visit, or you know for sure that you filled out a new patient form at least once, and those things are not in the records you receive, then: call, speak to medical records (if there isn't one, the receptionist will get you to the person who handles it), and say, "The records I received are missing at least This Thing and That Thing. Beyond those two Things, I am very concerned that I did not receive my whole chart, despite the fact that the records were certified. This is the second time this has happened. Would an attorney's office help your office understand what records I am specifically requesting?" Anyone with a brain will balk at having to deal with an attorney, because attorneys to a doctor's office = threat of a medical malpractice suit = insurance rates going through the roof if one is filed.

-Also ask your current doctor if this crappy doctor forwarded your chart on to the current practice. I'd be surprised if that didn't happen. If it did happen, get a copy of your chart that way. Compare it to the chart you got/get.

-If the old practice is affiliated with a hospital network, complain up to the network. Some states have laws that govern what network-affiliates can and cannot do, especially with regard to legibility of records. (My state is not your state, so YMMV.) And the network won't be happy with one of their affiliates jacking you around, because there's that medical malpractice thing again. (I'm not saying you should file such a claim or have grounds for such a claim. I'm saying that most physicians I know/have dealt with are super sensitive to the slimmest possibility of it. Their insurance company won't be happy with how they're doing things, either.)

-Do you have any bills or health insurance claim forms that have weird numbers (e.g., 491.21) on them? These are called ICD9 codes, and they're numeric codes for what you were diagnosed with. If you have these bills/forms with the ICD9 codes, you can see what you were diagnosed with vs. what the doctor charted in his notes. You can google the codes and the corresponding diagnosis will come up.

-If the doctor diagnosed you improperly, and that's in the chart and in the claim forms, then all you can do is play ball with the insurance company and calmly explain the situation. "This Doctor diagnosed me with ____, but labs later showed ___. My current doctor clinically confirmed the lab results. What are my options?"

I am not a lawyer, and none of this is legal advice.

(Edited to clarify a point.)
posted by coast99 at 12:21 PM on January 9, 2014 [1 favorite]

Response by poster: Thanks melissasaurus and coast99.
The things is,
-this doctor is running a one man private practice without any affiliation, office stuff or office facilities including photocopy machine or fax machine.

-And he takes no insurance, only cash.

-He agreed to send "medical records" by numerous insurance mail requests and finally he did gave out "something".

-Obviously he would not send out anything to my current doctor, I'm not seeing any shrink now, only LLMD. I don't think I have any primary psychiatric disorder when labs clears things out. So all past diagnosis are garbage neither me nor my LLMD cares.
-I do have those Dx codes and figured out the meaning, not having those crazy dx in his notes though, thanks for reminding.
-Your last advice is useful, I might have to do that, but I still don't know if wrong diagnosis matters to insurance.
posted by pack2themoon at 12:54 PM on January 9, 2014

Mod note: pack2themoon, you don't have to respond to every answer, might be best to sit back and let people make suggestions.
posted by mathowie (staff) at 2:04 PM on January 9, 2014

It's not uncommon for a doctor (or series of doctors) to go through several "short-list" diagnoses before finding out what exactly is wrong with someone. The insurance company should be dealing with this guy, not you. Send what you have to the insurance company, sign anything they need you to sign (release, etc.) and let them deal with him from there. As I see it, the bigggest problem here is that you paid him in full and with cash, leaving you no leverage. I would be a bit suspicious of any doctor who didn't have a copy or fax machine in this day and age, btw...
posted by summerstorm at 2:55 PM on January 9, 2014

If you have CPT diagnostic codes from the @#$% doctor, then I think you are OK - that is what he was treating you for and that is what the insurance company will (or won't) pay on. I don't think (although I am far from expert) that the insurance company would create new, additional diagnosis based on the written notes. However, if there is no diagnosis of record and the insurance company is going to decide the diagnosis based on these notes, I understand your concern.

I have one data point - not that this will happen to you but so others can see what you are concerned about - a friend with a diffuse, difficult to diagnose, difficult to treat disease (not Lymes but similar in that some doctors don't "believe" in it as an illness) had a seizure episode that was treated as psychosomatic episode - which was not only traumatic for her but meant that whenever she has deal with new doctors or hospitals, they are start out with the assumption that some or all of her problem is due to mental illness.

It doesn't make sense that the insurance company would rely on the wrong diagnosis to deny claims against your current diagnosis but I don't know enough to assure you it won't happen.
posted by metahawk at 3:41 PM on January 9, 2014

I think the worst that can happen is that your insurance premium in the future could be affected by you carrying a number of additional medical diagnoses. People with pre-existing conditions can no longer be denied insurance, but they may not be able to get the same/same cost insurance as they would otherwise. This could affect other forms of insurance too, for example, if you ever needed disability insurance and did not disclose that these diagnoses had been on your record, and then they were discovered, it would be a major problem.

It is true that often doctors consider multiple diagnoses, or change diagnoses during the course of treatment once additional information comes to light, but I would definitely think twice before submitting paperwork to an insurance company that gave me a diagnosis of psychosis or even just depression. Even if I had additional paperwork from a new physician stating that I did not have psychosis, insurance companies don't always use information in rational and helpful ways.
posted by treehorn+bunny at 10:19 PM on January 9, 2014 [2 favorites]