What to do if my insurance company sent me a letter declining a medication prescribed by my doctor?

The letter states that the a, “clinical reviewer” concluded that I did not take 4 other types of medication first, which I know they can do — but then went on to say, “records do not show that you have taken your drugs at the recommended times” and, “… Do not show that you have changed your diet and lifestyle to help reduce acid reflux”. Would this not require a violation of my HIPPA rights to collect this kind of information? This seems illegal to me.

Asked on April 19, 2014 under Insurance Law, Kentucky


FreeAdvice Contributing Attorney / FreeAdvice Contributing Attorney

Answered 6 years ago | Contributor

Based upon what you have written, you need to consult with your treating physician who prescribed you the medication that was declined to see what can be done to sort out the problem. If that does not resolve matters then you should consult with an attorney that does insurance law in your community. One can be found on attorneypages.com The information desired would not be a HIPPA violation.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.