Hipaa Healthcare Operations
hipaa healthcare operations
My husband recently had an operation and BCBS has paid partial. They are now contacting us for information.?
A company called “healthcare recoveries” that is representing BCBS has contacted us by phone and mail asking for further information about treatment and the injury. We have declined to “just talk” about his injury..They are claiming to be in full compliance with HIPAA and that we could be in breach of contract by not contacting them. I am assuming this is an angle to determine the expensive opertation not needed and stick us with the rest of the bills… Should they not just be contacting the provider directly? How do I handle this? What are my rights?
It is not injury that occured through a particular incident. He had a herniated disc that nearly severed two nerves that were coming out of the same opening… A congenital disorder. He was in a wheel chair for a month and had four preoperative clearences… So- if you are saying it’s routine- and we should just comply… wouldn’t it be routine to just look at the medical report from the provider?
They’re trying to figure out if the operation is recoverable. That means, maybe it was a workers comp claim, and they can get workers comp to pay for it – or maybe he got hit by a bus, and they can sue the bus company to get paid for it.
Your rights, are directly laid out in the contract. Call the number on the back of your card, and ask the provider if they hire this out. Many, many insurance companies do. The provider won’t know the CAUSE of the injury, or might not have noted it in the files. These guys just want to know if they can “subrogate” against someone else (not you) and get some money back from someone else.
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