Not diagnosed?

Question

My mother went to see the doctor cause she was getting coughs and he took an x-ray and just told her to quit smoking. He never said anything was wrong and the X-Ray results were normal. Now it is 4 months later and my mom's insurance company is sending her a booklet about COPD. How did my mom's insurance company get this information and did the doctor diagnose her with it and not tell her? And if that is the case, isn't that illegal?!
Oh yea, my mom was put on an inhaler so could the insurance company go through her pharmacy records and think it is COPD?

She was on an inhaler for 2 weeks and the bad cough went away, she was diagnosed with a chest infection. I just want to know why the insurance company is sending her booklets of COPD. If she has COPD, isn't that malpractice for the doctor not telling her?

Answer 1

You need to clarify a few things. One is why is she on an inhaler? Second if she was told to quit smoking that makes me wonder if the doc didn't see some problems starting on that chest X-ray. I would have you mom call the doc and talk to him about all of this including the COPD booklet. The insurance company though will know about her diagnosis though as they have to have a medical code for billing purposes such as code 1234 for sprained ankle if you get what I mean. Based on what they are paying the doc for is why they sent her the booklet. Your mother needs to call her doc to find out what the inhaler is for and just what her diagnosis is. Sounds like she didn't hear everything the doc said or misunderstood what he said and needs to get it clarified.

Answer 2

If she has medicare part D, they have to provide information about her perceived disease state. They look at what prescriptions you've been receiving and make a guess. Everytime you fill a prescription, the insurance company knows. They are separate from part A and B, so they rely on your prescription record to determine proper MTM coverage. The issue is what inhaler. Some inhalers are used almost exclusively for COPD.