Recently, I came across a discussion in the Brain Tumor Treatments Yahoo group, regarding a way that may help to overcome the typical insurance company denial on cancer treatments. I thought this could be very valuable for some of you, so here it is the information shared by one of the members from the above discussion group:
So your doctor ordered a test or treatment and your insurance company denied it. That is a typical cost saving method, Ok, here is what you should do:
1. Call the insurance company and tell them you want to speak with the HIPAA Compliance/Privacy Officer (by federal law, they have to have one).
2. Then ask them for the NAMES s well as CREDENTIALS of every person accessing your records to make that decision of denial. By law you have a right to that information.
3. They will almost always reverse the decision very shortly rather than admit that the committee is made up of low-paid H.S. graduates, looking at “criteria words” to make the medical decision to deny your care.
4. Even in the rare case where it is made by medical personnel, it is unlikely that it is made by a board-certified doctor in that specialty, and they DO NOT WANT YOU TO KNOW THIS!
5. Any refusal should be reported to the U.S. Office of Civil Rights (OCR.gov) as a HIPAA violation.