Posted by ksvt on November 11, 2000, at 22:05:43
In reply to Good pdoc, bad HMO, posted by allisonm on November 11, 2000, at 8:37:39
>Allison - maybe your pdoc will fare ok if he just ignores the request. Several years ago, my insurer sent a letter demanding an explanation for why my pdoc had billed me for 3 hours of therapy in one day. (I was pretty suicidal and he got my husband in for a couple of those hours.) My pdoc showed us the kind of letter he'd have to write to respond to the request and we decided it definitely wasn't the kind of thing we wanted circulating. He redid my bill for that month to omit reference to that session and I resubmitted the claim with the new bill. Either the insurance co. didn't care as long as they were then not being asked to pay for that session or it got lost in their bureaucratic haze. Either way, neither he nor I heard about it again. The same happened with an inquiry he got from them last year requesting an explanation for why he continued to prescribe ADs for me beyond the standard period called for in their protocol. I don't think he ever responded to that request either, all as far as I've been able to tell without consequence. He's an older guy and refuses to have anything to do with HMOs. I'm sure that has limited his patient base somewhat, but I think he thinks it's the only way he can practice. Hats off to your pdoc because it sounds like there could be a consequence to him. BTW, how are you doing? ksvt
After reading horror story after horror story about rotten pdocs, I thought I might throw in details of what happened at my session this week.
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> My pdoc at the end of the hour said that my HMO was asking to see my charts from my 2+ years with my him because they are going through some accreditation process and wanted to see charts for his longer-term patients. They wanted to see ALL of my records -- including the visits that they did not pay for (they only cover 20 per year at %50). He said no and suggested they pick someone else in the practice, but they insisted on mine saying that they have a right to see them and that I signed a consent form when I signed up. My pdoc told them he doesn't think people understand what they're signing when they sign up, so would not release my records and he brought the whole issue up with me to see what I wanted to do. If we refuse, the consequences are that they could disenroll me and throw him off their board.
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> I was planning on switching HMOs this fall anyway to one that seems to pay its doctors on time (mine had been cutting physicians fees and delaying payments), provide its customers paperwork they request without losing the requests (this happens to me every time), and to give approvals for treatments more expeditiously. I don't want them to see my charts because it's none of their business and they're not going to be my HMO shortly so its doubly none of their business. Plus my exhusband works for that HMO and while they insist on complete confidentiality, I don't trust them.
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> My doctor supports me and isn't especially concerned if they terminate him too. He said if he ever interviews for another HMO, they will ask him if he's ever been terminated by an insurance company and this possible termination may jeopardize his chances, but he doesn't think that being fired for defending patient confidentiality is a bad thing.
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> I think I am lucky.
>
> Allison
poster:ksvt
thread:2520
URL: http://www.dr-bob.org/babble/social/20001031/msgs/2550.html