Letters - you've got mail!!!

Instead of a visit from your friendly insurance representative demanding an immediate meeting without an appointment, you receive a two or three page letter from an insurance company requesting (demanding) a detailed reply concerning your office, your policies, information about your staff and billings.   They are likely to set out a list of patients whose files they want copies of.  The letter requests that you confirm that you will provide the information and failing which they may take other action -- contacting your "association".

The first thing you should do is take a deep breath and contact your lawyer.  Why your lawyer?  Because he or she will advise you as to whether you are obligated to provide some or any of the information being requested by the insurance company.  Unless you invoice the insurance companies directly, and even if you do, you are not under any compulsion to provide a "history" of your office. 

If the insurance company is not happy with your lack of a reply, they may terminate any direct billing you may have with the company, but remember that it is your patient who is ultimately responsible for your invoice.

You may be required to provide a copy of your patient records, including billings, but that is dependent upon whether a consent has been provided by the patient.  And remember, if the consent is part of an insurance application then an up to date consent should be obtained from the patient, since it is likely that the patient is unaware that he or she ever provided the consent for the release of the information.

The insurance company will likely also advise you that you must provide the information at no cost.  That is also not correct.  It will be the responsibility of whomever you are producing the records for to reimburse you for the time and cost.  But be reasonable.  A reasonable charge is not inappropriate but there is no common sense involved in creating a situation where the insurance company or the patient is irritated by an invoice for production of the material.

Again, the best thing to do when receiving a request for production of patient information is to seek legal advice to ensure that the documents are provided in accordance with the requirements of your licencing body.

have a great day
allan