01/17/2026
HAS YOUR HEALTH INSURANCE COMPANY DENIED YOUR CLAIM, TEST OR PROCEDURE?
Here is a process you can try to reverse that decision, if in fact your health insurance company has not complied with the law regarding claim review.
1. Call the insurance company and tell them you want to speak with the "HIPAA Compliance/Privacy Officer.” By federal law, they have to have one. If when you start the call you get a recording telling you that all calls may be recorded then RECORD THE CALL YOURSELF ALSO.
2. Then ask the compliance officer for the NAMES as well as CREDENTIALS of EVERY person accessing your medical records to make that decision of denial. By law you have an ABSOLUTE right to thIs information.
3. If anyone accessed your records who should not have the insurance company may reverse the decision very shortly rather than admit that the committee / people who denied your claim or request is A, or is made up of, low paid high school graduates or other non-medically credentialed persons, looking at "criteria words," who are making medical decisions to deny your care when they do not have the right or credentials to do so. Further, even if the decision was made by medical personnel - a doctor-, it may not have been made by a board certified doctor in that specialty and they likely would not want you to discover this and they may rather just pay the claim.
4. Any refusal should be reported to the US Office of Civil Rights (OCR.gov) as a HIPAA violation.
And of course, if you are denied your access or information rights - or improperly denied a claim - contact us to see how we can help.
