"doctors and insurance"?

Question

Does anyone know exactly what medical information is passed from my doctor to my insurance company? If I admitted to doing recreational drugs will that specific information be reported to the health insurance company? Does the insurance company know if I go to the doctor for pain in my eye or pain in my foot? What does the doctor tell the insurance? I've always wondered about the codes and so forth.

Answer 1

the ins co would only know about your recreational usage if they request your MEDICAL HISTORY/RECORDS from the doctor's office.

And...yes, they would know about the eye vs foot because remember, they're paying the bill--they need to know where the pain is, injury, etc.
For ex, I cut my hand with scissors, I was trimming my dog's ears. So the ins co kicked it back and was saying it was "work related"--which it wasnt--they eventually paid, but I'm using this as an example of the info that is shared by the dr and the ins co.

Answer 2

Almost all information about your health care goes to your insurance company, no matter what documents you sign.

Doctors have to report a diagnosis to your health insurance using a special code. And this code indicates what happened to you: such as 'Insect Bite, Finger, Left', 'Sprain, Ankle, Right' or 'Office Visit, <15 Minutes, Low Complexity'.

But the good news is that the doctors do not normally report the circumstances of the problem / disease. in other words, you see that the 'codes' above don't mention HOW the injury happened.

In the U.S., a federal law protects you and your doctor from any information you share, unless this information is requested by the government. In other words, if you went to the doctor, and told them that you abused a certain drug, they can, and will, treat you without telling anyone outside the office. As far as anyone outside the office knows, you accidentally overdosed on Tylenol.

If we couldn't go to the doctor without telling them we did a drug, then people wouldn't go. People would be afraid of seeking medical care, and a lot more of us would die.

Answer 3

Doctors have to submit a diagnosis code as a part of the billing process. The diagnosis code tells the insurance company what you were treated for. Lower Leg Pain would be coded 789.01 and Pain in your arm would be 729.5. As far as past history, if your insurance wanted specific information, they could request copies of your medical chart, but generally all they get is a bill that has those diagnosis codes on them. If you are looking to purchase a health insurance policy, the company would likely read the notes your doctor has put in your chart, including any narratives you have provided about prior habits, health problems, etc.

Answer 4

The codes, which medical offices are required to send to the insurance company in order to receive their payment (and for you to get "discount" care for a set fee), are established descriptions of procedures and health conditions.

For example, on a form you might find a code for "Office visit - 15 minutes", or a code for "injury to the spine cervical area".

The details of what your say to the doctor are between you and the doctor. However, the doctor must inform the insurance company what he did and why he did it. So, in the case of the drugs, if an illness or treatment occurred directly as a result, they would know.

On a bright note (depending on your point of view), the insurance industry is so automated, convoluted and full of red tape, that they are not likely to be concerned at all about your specifics - their interest is in making sure they don't pay for anything they deem unnecessary.

Answer 5

The codes that are on the insurance forms indicate what treatment you and your insurance company are being billed for. If your codes are for a "foot xray" and "cast", they can figure out you broke something in your foot or ankle.

The prescriptions you have filled that are paid for in part by the insurance company will also give information to your insurance company. For instance, if you are getting prescriptions for anti depressants, they can figure out you might have a mental disorder. If you are getting diet pills, they can figure out that you are over weight, etc.

Unless you are checked into the hospital, they normally do not get "casual drugs" information. If you are in the hospital and it is reflected in your medical records, they can get a copy if they request it.

Answer 6

The insurance companies get your medical records from the doctor only if they ask. What is coded is regarding the disease process and the treatment.

Say you have chronic headaches-the chronic headaches will be coded along with whatever the doctor used to treat or diagnose them.

I've done medical coding and billing before. But from now on I would suggest you don't tell your doctor anything you don't want him to know. Sometimes medical records can be subpoenaed and it would come out somewhere that you did recreational drugs.

Answer 7

You don't have to admit to using recreational drugs when it doesn't pertain to what your being treated for. No your insurance company will not get this information unless your case goes to court and all of your chart will be used as evidence. Admitting that you use marijuana is most likely not of anything of significance. However admitting to using cocaine and going in for chest pain is a different case. Cocaine may cause chest pain heart arrhythmia's and may lead to a heart attack. The only time you should disclose recreational drugs is if you are requesting detoxification from those drugs.

Answer 8

You signed a release when you started going to the doctor that allows them to send your paperwork to the insurance company. The codes are their office codes, they send something different to your insurance company. They have to. They have to know what you were seen for to determine whether or not or how much they will pay.

Yes, they would find out if you were on drugs.

Answer 9

Yes I have actually. The other day Sam I Am stopped by my house for some green eggs and ham and he informed me that Hillary enjoyed them also :)