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Who gets access to medical records pulled during DI medical underwriting?

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  • Who gets access to medical records pulled during DI medical underwriting?

    Hello,

    I am currently shopping around rates for true own occupation DI, however, I have some questions that are unique to my medical background. When an insurance company begins looking at my pharmacy records, they will find medications that were prescribed 7-8+ years ago for mental health issues and substance use prior to beginning my medical training. These issues have been in remission since that time. Information regarding this medical history was not disclosed to the medical board/DEA at the advice of my attorney and these issues have never come up throughout my training.

    My question is, once the insurance companies request medical records who will have access to this information? Is there anyway that the information that is gathered for determining DI eligibility could make its way to state medical boards, DEA, etc. or is it solely used by the insurance company?

    Any insight into how this process works in the background would be greatly appreciated. Thank you in advance.

  • #2
    i cannot imagine that any DI company would do anything with these records outside of strictest confidentiality.

    if they did and it led to loss of licensure i would think you could sue them with a high degree of success for a great deal of money. the breach of contract and damages would be fairly indisputable.

    you might ask the attorney what she thinks.

    i'm a little bit confused though, it seems like one of 2 things is going on:
    1) your medical board/DEA didn't require you to disclose the substance abuse, in which case it's out of the time frame when it seems they would care about it even if they found out. I doubt the DEA works this way but I've never looked into it.
    2) on the advice of an attorney you chose to omit requested info from forms?

    if it's option 2 then this thread might need to be locked as we cannot give advice on how to evade licensing laws or DEA certification.....

    Comment


    • #3
      back in the stone ages when I applied for DI, I recall they only wanted to speak to my docs in the last 3 years.

      agree with MPMD...usually the licensing questions are have you "ever" had such and such. hopefully your attorney steered you correctly.

      this question has come up here a few times in the lifespan of this forum. stressful situation--sending you good vibes.

      Comment


      • #4
        Originally posted by MPMD View Post
        i cannot imagine that any DI company would do anything with these records outside of strictest confidentiality.

        if they did and it led to loss of licensure i would think you could sue them with a high degree of success for a great deal of money. the breach of contract and damages would be fairly indisputable.

        you might ask the attorney what she thinks.

        i'm a little bit confused though, it seems like one of 2 things is going on:
        1) your medical board/DEA didn't require you to disclose the substance abuse, in which case it's out of the time frame when it seems they would care about it even if they found out. I doubt the DEA works this way but I've never looked into it.
        2) on the advice of an attorney you chose to omit requested info from forms?

        if it's option 2 then this thread might need to be locked as we cannot give advice on how to evade licensing laws or DEA certification.....
        Thank you both for your input, it is much appreciated. As you can imagine I spent a lot of time consulting with multiple attorneys when filling out the appropriate paperwork and answered all questions as they were asked truthfully with attorneys experienced dealing with this situation.

        Comment


        • #5
          Originally posted by impendingdoom View Post
          Hello,

          I am currently shopping around rates for true own occupation DI, however, I have some questions that are unique to my medical background. When an insurance company begins looking at my pharmacy records, they will find medications that were prescribed 7-8+ years ago for mental health issues and substance use prior to beginning my medical training. These issues have been in remission since that time. Information regarding this medical history was not disclosed to the medical board/DEA at the advice of my attorney and these issues have never come up throughout my training.

          My question is, once the insurance companies request medical records who will have access to this information? Is there anyway that the information that is gathered for determining DI eligibility could make its way to state medical boards, DEA, etc. or is it solely used by the insurance company?

          Any insight into how this process works in the background would be greatly appreciated. Thank you in advance.
          They are covered under HIPPA, not only will they not share with anyone they won't even tell your broker. It happens all the time to us that a client does not tell us what is there, they go into underwriting, and then there are questions about why the case did not come out of underwriting cleanly and we can't tell the client because we don't know. It is helpful for you to disclose to the the broker so that that can help determine what carrier has the best policy for that situation so be sure you work with someone that will do a pre-screen to the carriers.
          Scott Nelson-Archer, CLU, ChFC
          303-953-0263 Direct / [email protected]

          Comment


          • #6
            Originally posted by impendingdoom View Post

            Thank you both for your input, it is much appreciated. As you can imagine I spent a lot of time consulting with multiple attorneys when filling out the appropriate paperwork and answered all questions as they were asked truthfully with attorneys experienced dealing with this situation.
            From your screen name, you are probably justified to have anxiety. To accomplish your goals, you found it beneficial to strategize the answers.
            Those answers need to fit the facts. If the records do come out, and your answers don’t, that is on you. Attorneys give advice, you make the decisions.

            Disability claim, malpractice claim or any insurance or licensing problem will likely have an attorney that is not advocating for you. Adversary attorneys aren’t friendly.
            Just make sure your answers fit the facts.
            DI insurance is not going to be the last time
            you feel impendingdoom.

            Comment


            • #7
              I cant remember the wording but 100% of applications for staff, malpractice and others have some question on in in regards to this. Whether it is current or previous use. Not being completely honest may come back to haunt you. Information in the electronic age , does not disappear.

              Comment


              • #8
                Originally posted by impendingdoom View Post
                Hello,

                I am currently shopping around rates for true own occupation DI, however, I have some questions that are unique to my medical background. When an insurance company begins looking at my pharmacy records, they will find medications that were prescribed 7-8+ years ago for mental health issues and substance use prior to beginning my medical training. These issues have been in remission since that time. Information regarding this medical history was not disclosed to the medical board/DEA at the advice of my attorney and these issues have never come up throughout my training.

                My question is, once the insurance companies request medical records who will have access to this information? Is there anyway that the information that is gathered for determining DI eligibility could make its way to state medical boards, DEA, etc. or is it solely used by the insurance company?

                Any insight into how this process works in the background would be greatly appreciated. Thank you in advance.

                Hello

                I'm in a similiar situation as you. I'm a new attending and shopping around for DI. I'm curious what route you took and if you have chosen a DI?
                I had a brief hx of adjustment disorder during intern year of residency in 2017 and was given wellbutrin. I decided to stay on it as I liked how i felt . I'm curious if this will come up and if the insurance will void the mental health rider and if this affects any other fees/ policies bc of my med hx. Their mental health exclusion seems over the top and makes me upset

                Comment


                • #9
                  Just be honest in the way you answer the questions asked of you. Today's rules are 3 or more years from when medication was last dispensed then there will not be an exclusion for mental nervous, If there has been meds dispensed in the last 36 months then you will end up with a M/N exclusion but once 36 months has elapsed you can get the exclusion removed. This is very common and easy to do so you know.
                  Scott Nelson-Archer, CLU, ChFC
                  303-953-0263 Direct / [email protected]

                  Comment


                  • #10
                    If you answered the questions honestly and went over them with a qualified attorney, I cannot see the problem as far as your license is concerned. If, as people are assuming, the OP had not answered truthfully on the DEA application, then that would be cause for worry. As it is, the DEA granted a license on the basis of true answers to the questions it asked, same as for anyone else.

                    I don't remember what the questions are or the timeframe covered. But an honest answer is an honest answer.

                    As for the DEA funding out from the insurance company, find out what? The Administration already knows the answers it cares about.

                    My only anxiety might be to check with another lawyer expert in this area to make sure they agree with the advice you were given.

                    Comment

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