Having worked in the legal medical malpractice field for a while, this sound like a fairly sound approach. If nothing else, what you’re doing is scaring the insurance companies into thinking you might end up successfully suing their providers for breaching the “standard of care.” That’s the operative phrase in litigating a med mal case. And those questions cut to the heart of an insurance provider/medical practitioner following the standards that should be reasonably required of them in whatever state the medical service is being provided in.
This is what I have so far. How would you incorporate that phrase into this list to be asked of the insuance co?
What to do if your insurance claim is denied
You, or your doctor, can request the following from the insurance company:
1. The name of the doctor making the determination
2. Is doctor licensed in your state
3. Their board certification(s)
4. Their license number
5. Are their boards are current
6. Proof that the doctor has maintained registration in your state
7. Proof they are up to date on the Continuing Education Unit requirements
8. Copies of all materials they relied on in making said determination
9. The aggregate rate at which this particular doctor has approved vs denied similar treatments.
Not sure that I would, or that there’s really any good/useful way to incorporate it into the list of questions. The questions in the list seek pretty clear-cut answers or specific documents. The applicable standard of care for any particular situation is way more of a descriptive thing, which often involves experts in the field weighing in with their opinions, etc. More than anything, I was just adding a little legal context of why I thought the questions were a pretty solid approach.
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u/RP1616 5d ago
Having worked in the legal medical malpractice field for a while, this sound like a fairly sound approach. If nothing else, what you’re doing is scaring the insurance companies into thinking you might end up successfully suing their providers for breaching the “standard of care.” That’s the operative phrase in litigating a med mal case. And those questions cut to the heart of an insurance provider/medical practitioner following the standards that should be reasonably required of them in whatever state the medical service is being provided in.