Errors on Your Medical Records

Mistakes can happen many different ways.

Someone could steal your identity and use your insurance or get a new policy. Besides having bills to pay you will have their medical problems interspersed with yours. Health insurance has a pay limit, all are not the same so you might run out with a lot of expensive procedures.

You could loan someone who has no insurance your card. Besides getting into legal trouble your record will have a combination of yours and the other persons medical issues. This is dangerous because this could cause the wrong treatment for both.

Your medical practitioner might not be good with record keeping. Your files could be misplaced, lost or misappropriated due to sloppy habits.

You could have made a deal with your doctor. You wanted this therapy for a certain illness but your insurance doesn't pay for your illness. You have the doc change the illness to fit the reimbursement.

The health care practitioner does the above without you really knowing what was going on.

There is fraudulent practice where procedures were put on your record and they were not needed or done but you get billed and it becomes part of your medical history.

The fraudulent practice of putting a false illness and doing a unneeded therapy for the monetary gain. If you initially suspect something, like a disease out of nowhere get other opinions. Be very careful with forms that you are given. Make sure you read them carefully. If you are given something that does not apply to you or you do not understand what it means do not sign it. For instance some forms will protect the clinician legally by having you check off symptoms. If you do not have symptoms do not check it off. I always write my own information to make sure the correct information is there

Upcoding could happen when you get a code and are billed for a diagnosis that is more serious and a higher payment than it really is.

Double billing happens when you are billed more than one time for the same thing. It could be your insurance and you personally are billed. Medicaid and medicare are both billed. Workers compensation and your regular insurance are both billed. Or two different health care providers bill you for the same service in a hospital setting.

How ever the mistake got on your record you want to straighten it out. You need to know your own medical history because it is important information.

Always check with the three credit bureaus to make sure you do not have any unauthorized debts. Every year ask your insurance company for a copy of all the money that the insurance paid out on your policy to see if someone else had used it.

Despite using electronic medical records ( EMR), people still have to enter the data. If it is entered wrong you have incorrect information which might be harder to correct. Not all EMR software is the same. Some are a lot better then others. And it takes knowledge to pick which ones are good. As with written records, just because it is documented does not mean the treatment or therapy was done or even the diagnosis is correct. The fact that it is computerized might just make it neater and easier to read.

Also being computerized might make the whole record easier for an unauthorized person to have access to. Before with paper charts it would be piecemeal and the person would physically have to go to a specific location and maybe deal with lots of folders. Now they could get everything from the comfort of their computer at any location. And of course the fear of either by mistake or malicious intent having our private information downloaded to so web page for everyone to see.

In order to correct an error you have to know it exists. Do not be afraid to call your health care provider you you find an error. Do not be put off by icy or uninterested tones by clerical staff or the provider. Sometimes the first inkling you have that there a problem will be the bill. You might get an unusually high bill even if it is paid for by your insurance. Insurance companies send explanations of benefits (EOB) which have a listing of medical procedures, what was charged by the doctor, what the insurance company paid and finally what you owe.

Some doctors will say they take your particular insurance. Yes, but are they under contract with your insurance company. If they are not they can charge you anything they want. Your insurance company may not reimburse you or have to pay the difference and your part can be very expensive. You need to verify with your insurance company the relationship your clinician has with them.

Each insurance company has its own set of procedures and rules so you need to read the booklets they send you. Doctors will send you a bill. If the amount you owe on the bill isn't the same as the EOB you need to find out why. The EOB has numbers for you to call in case of any questions. I have cleared mistakes in one call. One of the most common mistakes I find is dealing with co-payments. Not every visit to a health facility merits a co-payment. The insurance book tells you when to pay it. Sometimes on the doctors bill they forget to deduct the co-payment that you paid on your visit. Another is computer glitches, you might need human eyes to look at the problem and correct it. Remember, all you have to know is your insurance, they have to know them all.

You have the right to have access to your medical records. You can ask for a copy of your chart and charges after your visit. You can put it in writing which record you want and they can send it to you later. You then need to go over them carefully. If you find errors then talk to your doctor about what you find. You can put an addendum to your chart if he refuses to amend the record. The addendum will list your corrections you want. Of course if you find billing and records of treatments you never received you must find out if it is a mistake or fraud.

When trying to find out what you were actually billed for you will come across different types of medical codes. Insurance reimburses on what codes are submitted. If you are a private payer they charge on what the code is, not the written description. There are books on medical diagnostic and billing codes, or you can google the codes to find out what they mean. The wrong code can mean the wrong diagnosis, or a wrong code can mean more money is charged.

Unfortunately for all of us the sale of medical records is big business. People working in clinics and doctors' offices copy and pass the information on to people who have plans for it. The old fashion dumpster diving is still in use at this time to get unshredded information. How often have you heard about passersby finding personal and medical information on the sidewalk outside some medical building.

Some unscrupulous people even open temporary clinics in order to steal your information. There are phoney healthcare websites that are for the expressed purpose of phishing. Even telephone calls to you pretending to be an official health care facility treating you. It isn't necessary that you have good insurance or any insurance for that matter. They will try and make sure that you are responsible for the costs. The costs can be huge if some sort of major surgery is done. This could even cause a mix up with your real records and make you ineligible for treatment or even use your insurance to the max.

Have your doctor give you copies of your medical record and find out how to restrict access and find out about any inquires on them. Always bring your own copies with you and compare them to your physicians to make sure they match up.

If you believe there is fraud then contact the fraud hotline of your insurance company and your states attorney general. If you receive medicare or medicaid then contact The Centers for Medicare and Medicaid Services (CMS) and your state attorney general.