If my doctor put inaccurate information into my medical file which resulted in a denial of an insurance claim, how can I correct it? 

Question Details:

I am a international student and studying in USA.My HTH insurance started 11/18/09. Before that I had a PSI insurance. I was playing tennis on 11/25 when I hurt my shoulder. So I made an appointment with the doctor at the hospital. The appointment was on 12/18. He checked and told me to have an MRI done. I did an MRI on12/25. I again had an appointment with him in 01/10. I didn't ask for reports that time. Now the insurance company has denied my coverage saying that the doctor wrote on the report that I had a pain in shoulder for 5 months but I never mentioned that; he completely lied. Can I sue the doctor? Can I get the claim denial reversed?

Asked 4/21/2010 under Insurance Law | 338 View(s) | More Legal Topics

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Insurance Law Law Answers

If the doctor provided inaccurate information in your medical file, you may be able to sue him, possibly in malpractice (if it was due to incompetence) or possibly in fraud (if it was deliberate; e.g. if he somehow benefitted from your denial). You would need an attorney for a lawsuit like that--suing doctors is usually fairly involved and expensive, since you can bet the doctor will have an attorney defending him. Also, all you can sue for monetarily is any actual losses you've suffered to date, so if you have not had any large out of pocket medical expenses for which you were not covered by insurance, there's little monetary recovery to offset the cost of a lawsuit. (You can also sue for an order forcing him to correct incorrect information.)

Is it possible it was an innocent mistake--that you mispoke or he misheard or both? Have you spoken with the doctor and explained to him that this was in error? If you haven't yet, you should try--he may be more than willing to correct the file and help you out.

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