Insurance/Legal Question - Post-Accident TMI?

"Stef Schrader" (stefschrader) 01/14/2014 at 12:49 • Filed to: insurance claims, legal issues, privacy

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So, this is related to happened back in August. Now that I've finally got a tiny bit of extra time (sort of, but let's be honest, not really ) to deal with it, I sent over a bunch of bills, records and receipts related to medical issues resulting from the punt.

Both Austin PD and my insurance company said it was 100% the other party's fault for making an illegal turn in front of the Lulzcer, so I'm handling medical claims through the other party's insurance.

They've received my big ol' fax of all the records I have yesterday, so today I get a response asking for:

Treatment records from each visit

Itemized bills with CPT codes (Can someone translate "CPT" into non-medical-office-worker speak?)

Mind you, most of the paperwork I sent over was totally fine when I logged them through my own insurance's personal injury protection policy—sans the need for extra information.

Most of the documents I sent over were receipts from visits that showed—in general terms, but with enough detail to show I'm not trying to bill auto insurance for unrelated issues—what was being examined. Exception: one office was able to log directly with my insurance for PIP, so I have a letter from them with the reason for treatment and dates of visits.

I'm very cautious of overly-ambitious asks from insurance companies, seeing how I was originally asked for access to my entire medical records from both insurance companies. (Yeah, that's a no, and I find it extremely offensive that companies even ASK for that.)

I'm also quite guarded of my privacy—what ain't nobody's business ain't nobody's business.

So, Oppo legal/insurance types—is this actually necessary information to process the claim or should I politely tell them to mind their own business?

I'm in Texas, so I'm probably going to ask the !!!error: Indecipherable SUB-paragraph formatting!!! what to do in this situation, but I figured I'd put the question here just in case anyone has any advice and follow up if TDI* has anything to say.

*Sidenote: I'm so disappointed that I'm not talking about turbodiesels with this acronym that it's not even funny.

**ETA: TDI said it was a fair ask, but if I'm concerned about privacy, I can ask to see if they'd take alternative documentation instead of records from my visit.

RamblinRover Luxury-Yacht > Stef Schrader 01/14/2014 at 13:53

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CPT codes are a classification for type of injury/treatment, by code. Asking you for an itemized bill with CPT codes when their own lazy asses could look them up is obnoxious, but not completely insane. Anything that insurance does or does not cover is based on CPT codes, but they're often transparent to the client.

They are, in the guise of making sure that you aren't getting any treatment that insurance isn't supposed to cover, stalling. Also CYA-ing.

EDIT to add: IANAL, obviously. Nor a Texan.

Stef Schrader > RamblinRover Luxury-Yacht 01/14/2014 at 13:57

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I figured this was a stall time/try to see if there's anything they don't want to pay move, hence for the suspicion.

Thanks!

Drsweetdik > Stef Schrader 01/14/2014 at 14:02

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Hire an attorney.

Aaron James > Stef Schrader 01/14/2014 at 14:03

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Yes that is exactly what it is. The longer the money sits in their accounts, the longer they can make interest off it. It's a very common tactic, but the Insurance company will never pay it out without correct and concise CPT codes. The good news is that your doctors billing company knows exactly what is needed so other than time, it's not a big deal.

Cixelsyd > Stef Schrader 01/14/2014 at 14:05

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I'm very cautious of overly-ambitious asks from insurance companies, seeing how I was originally asked for access to my entire medical records from both insurance companies. (Yeah, that's a no, and I find it extremely offensive that companies even ASK for that.)

I'm also quite guarded of my privacy—what ain't nobody's business ain't nobody's business.

Except, if they are paying the bills, it is their business. They are looking to make sure the injuries you sought treatment for or are seeking compensation for are related to the accident and not pre-existing injuries that they are not responsible for.

I'm a defense lawyer and I routinely ask for the previous 5 years of medical records from any provider you've ever seen when I am defending a case.

jlmounce > Stef Schrader 01/14/2014 at 14:06

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Lawyer. Now! I'm not sure which insurance company you are working for, but they are asking you for information that would be nearly impossible for you to provide them. Those codes are internal medical billing codes and unless you work in that industry, they would be both vague and nonsensical to you.

You can try getting your treatment doctors and facilities to provide you with them, but given HIPPA laws, I really doubt they'll do that.

If the company is giving you a run around, retain an attorney to help. There are many personal injury lawyers that don't take a fee unless there is a settlement.

Clown Shoe Pilot > Stef Schrader 01/14/2014 at 14:10

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They probably could have done a better job of asking, but what's likely happening is that the at-fault's insurance company is just trying to make sure that only injuries pertinent to the crash are paid for.

CPT stands for "Current Procedural Terminology" and when you go to the doctor, all the stuff the doctor does has a CPT "bucket" that it can be classified in. So if you go to the doc because of the accident and he looks you over and treats you for injuries, and then at the end of the visit you say "oh, hey doc, I also have this cough" and then you get some tests for that, your visit will have several codes on it. The at-fault insurance company wants to make sure that they're not paying for other services that might have happened in the same visit, if those services were treatment for things not related to the crash.

Stef Schrader > Aaron James 01/14/2014 at 14:31

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Ah, cool. I thought these were on there, but if it's a simple thing to provide, I can dig up the CPT codes.

The records ask is the one I'm more concerned about. My visits were basically "I'm in pain. Fix it." but I'm not sure what would be gained over getting the CPT codes from having my records. Again, it's the whole privacy issue. If my insurance company didn't need the full records, why does this one?

Stef Schrader > Clown Shoe Pilot 01/14/2014 at 14:37

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That makes sense. Thanks for the translation, heh.

Stef Schrader > jlmounce 01/14/2014 at 14:42

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Yeah—I haven't hired one yet, but that's my back-up plan if I can't resolve it on my own.

I don't think the CPT codes are all that hard to get. I think they were on a couple of the receipts I was given anyway, seeing how the other party's insurance was only asking for CPT codes from a couple offices I saw.

It's the request for records that worries me more, TBH. That doesn't sound like necessary information to settle a claim, especially if they have the CPT codes in front of 'em.

Aaron James > Stef Schrader 01/14/2014 at 14:42

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You really shouldn't have to do anything, The same letter about the CPT codes that you got also went to your doctor. If your doctor wants to get paid and they do, they'll resubmit it. I don't blame you on the privacy aspect. It's only getting more important as time goes on. Good luck to you, hopefully everything works out on the flip side.

Aaron James > Stef Schrader 01/14/2014 at 14:44

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Re-reading it, are you submitting everything yourself so that you can get reimbursed?

Stef Schrader > Aaron James 01/14/2014 at 14:54

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Yep.

Aaron James > Stef Schrader 01/14/2014 at 14:57

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Yuck, hopefully they don't jerk you around too much. If they ask for more after you re-submit you might want to look into talking to a lawyer. If you get stuck you may be able to talk with the billing people from your doctors office and they may be able to help you.

jlmounce > Stef Schrader 01/14/2014 at 15:21

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The request for records is pretty standard actually. They aren't obligated to pay your for issues that were there prior to the accident. Verifying your patient records are howy they can prove what is owed and what isn't.

With that being said, when we worked BI claims at state farm, this is information that we requested from the attending physicians. You have to have a HIPPA request for it and most patients don't have access to those records.

Dr. Hoon > Stef Schrader 01/15/2014 at 17:17

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Here starts the likely unhelpful post, Stef... My experience with this situation is as a surgeon. We physicians commonly get requests like this in similar situations. It appears to me that they pretty much get to request whatever they want. HIPPA says we don't release anything to anybody, but the insurance companies force you to sign a release for it all before they will do anything for you. Sucks, but FWIW that's been my observation. If you want to fight about it, I suspect that lawyering-up is your only move. I completely understand your privacy concerns. HIPPA is annoying, counterproductive, stupid and still doesn't protect people. Which, of course is typical for government legislation. On the bright side, the general public is already aware of your raging Porsche addiction, so you don't have that to hide... :)

Dr. Hoon > Cixelsyd 01/15/2014 at 17:19

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Should have read this post before I posted. What he said, only he said it better.

Cixelsyd > jlmounce 01/15/2014 at 17:30

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You can try getting your treatment doctors and facilities to provide you with them, but given HIPPA laws, I really doubt they'll do that.

As a health care lawyer, I can tell you that HIPAA gives patients an absolute right to their own records. It's actually a violation of HIPAA for a provider not to give you a copy of your own records upon request.

jlmounce > Cixelsyd 01/15/2014 at 17:53

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That's good to know. When I worked in claims for State Farm, we never requested directly from the customer. It was a pretty huge deal with privacy concerns and such. NOt working on the other end, I didn't know that was the case.

Stef Schrader > Dr. Hoon 01/15/2014 at 17:57

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I actually refused to sign over any of the blanket releases they initially requested. It's not any of their business what kind of bowel movement issues I had in 2002. Okay, now I'm just making up imaginary problems because I don't think I had poopin' problems in high school, but if I did, they shouldn't have blanket, unrestricted access to that on principle.

So, this is why I'm now having to dig up the related records on my own—because I'm a bashful pooper. (Just kidding. No, I'm not. Actually, I kind of revel in my BMs. But I do believe in my rights to privacy, dadgummit.)

I've already gathered up a few of the records they requested, and they're less TMI than I thought: person has _____ issue from ____ incident. Details. Treatment prescribed. Follow-ups needed.