By DeathbyWording - United States - Vernon
Today, my doctor said I "might" have an enlarged heart and an irregular heartbeat. It "could" be seriously life-threatening and I "should" go to a specialist for further tests. My insurance refuses to cover my consultation with the specialist because the doctor's wording is too uncertain. FML
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By  soactually  |  4

But... that's how medicine works. The doctor can't say for sure whether that's the situation; that's what the specialist and the further tests are FOR. The problem isn't your doctor, it's the insurance company.

  cheeeksss  |  29

Very true. The doctor worded it that way because he isn't a specialist for that particular area (which is why he said OP should go to them). The doctor thus cannot properly diagnose OP. It definitely faults with the insurance company. Can't stand how money hungry they are.

  Fairyjoshy  |  13

34, I wouldn't be surprised if insurance companies regularly change what terminology would require them to cover something - cheating people out of treatment is how they make their money, after all.

  Axel5238  |  29

Most insurance companies try to avoid paying unless it's fairly clear cut and even then they may only pay part of it. It's still a buisness regardless.

  Nyattack  |  14

Wow... This healthcare system is nuts, they're basically denying people the right to (urgent) medical care, letting people die ! I'm glad to be in Europe !

  Kiernan151  |  25

I don't know about all of your guys health care, but mine isn't like that. I jist have a limit to how many times I can go to my doctor in one month (15) and if I surpass that I have to pay for it myself.

By  dafluckster  |  6

Well, an irregular heartbeat isn't difficult to objectively figure out, but the enlarged heart and anything else requires further evaluation to be sure. That's horrible.

By  dorothy675  |  15

Here's what you can do:

1) call your insurance company and ask with the HIPAA Compliance/Privacy Officer

2) Then ask them for the names as well as credentials of every person accessing your record that made the decision of denial.

3) They will probably reverse the decision rather than admit that their committee has low paid high school graduates who usually do this decision making by looking for "criteria words" to deny healthcare.

4) If they refuse any of this it should be reported to the U.S. Office of Civil Rights

Hope this helps!


this is bullshit, okay. First of all, HIPAA non-compliance has its own website. It's not civil rights. Civil rights is like race and gender and sexual orientation, protected classes like that. Secondly, the people who are on insurance panels are usually former medical professionals, not pure HS graduates. This stupid picture was spreading on the internet and it's a lie. If diagnostics and coverages were that easy to get reversed nobody would ever have problems.

I hate the US system of healthcare too but spreading stuff like this helps NOBODY.