How do medical records work?

Question

Are medical records sort of like a credit report, where an insurance company can put in your information and automatically see all of your records, or do you have to give them the name of your doctor for them to find the records? I'm just curious to see how a medical insurance company researches your records when you apply. I signed the release of records, but I have not had any medical problems in a while. I am a little scared that I may have forgotten about something that I didn't list on the application that will not allow me to be approved. Thanks!

Answer 1

A little of both. There is no widely recognized central clearinghouse for medical records information, not in the same way as the big three credit bureaus. The privacy laws in the U.S., particularly HIPAA, make the situation more complicated too.

There is one company that represents a consortium of several hundred medical entities, called MIB Group. You can request your own records from them, free, once a year. What they send you will probably be approximately the same as what an insurance company will find out when researching your records. There are no guarantees that insurance companies won't have other sources too, but this is about the best you can do. Here's the URL for info about requesting your records from MIB - http://www.mib.com/html/request_your_record.html

If it turns out that you did forget something on the application, and if the insurance company challenges you about it, just say that you forgot. They aren't going to deny you coverage for being human!

Answer 2

They can't see details, but they CAN see that payments were sent out. When the insurance company does the research and sees all the payments, then they ask you for the release of records so they can get detailed info.

Answer 3

Sometimes an insurance company wants to see the doctor's notes to process a claim. Doctors occasionally bill a superlong visit, but if they write six words in the chart, they're NOT going to get paid for that superlong visit, they're going to get the generic quickie visit.