Discussions By Condition: Diabetes

HELP!- wrong diagnosis - can't get insurance

Posted In: Diabetes 13 Replies
  • Posted By: erineb
  • January 22, 2007
  • 03:56 AM

My doctor wrote the word Diabetes in my chart before I left to move to GA. Now I can't get health insurance here. My FGP tests have all been normal. He did not tell me I had diabetes. When I called him about it he said I don't need any diet changes or treatment. He based my diagnosis on one A1C test that was 6.1. Everything I have read says A1C is to monitor diabetics and not to diagnose it!! Anyone know how I can fight this?

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  • You are correct that an HbA1c of 6.1 does not necessarily mean diabetes and in fact, it would be malpractice to even diagnose diabetes based simply on an A1c because there are many other diseases and even medications that can cause high A1c levels and even false readings. If you have normal fasting blood sugars or pass a glucose tolerance test you are definitely not diabetic.However, I would caution you to keep an eye on things because a form of adult diabetes called LADA does start off "slow" and you might want to make sure this has been ruled out. This form is common to those of normal weight over the age of 30. Mildly elevated blood sugars are usually the first signs.There are several things you need to do to help yourself in regard to the insurance problem. First, you need insurance. I checked and your state has a major medical risk insurance pool. If you can show that you were turned down for other insurance you can quailify for the state program. The drawback is that it will probably not be cheap. The plus side is your diabetes care will be covered and since it takes insurance to get insurance it will give you some coverage until you can get a better plan. The longer you go without insurance the harded it will be to get it in the future -- even if you have no medical problems.Your state's link (assuming you are in GA) to major medical information is http://rmictr.gsu.edu/FAQS/Health.htm.I am not one to threaten idly. However, your doctor has caused you major financial hardship and exposed you to tremendous health risks by not telling you that he/she diagnosed you with diabetes. Start by asking that your medical information be corrected along with a letter to the insurance company. If the doctor refuses and states that you do have diabetes, have proof that you don't (you said you had a normal fasting glucose level). Copy the doctor with this result and threaten to report him/her to the state board for medical malpractice. Even if you do have diabetes the fact that the doctor did not tell you is well, very, very serious.You also should file a request with the insurance company who turned you down for reconsideration. Send them the lab reports showing you are not diabetic. If they still refuse you, tell them you will contact the state insurance commissioner and file a complaint for being falsely denied coverage.I know this is a lot of work. I help patients in your situation all the time and the battle is always uphill. But with enough effort you can get this corrected.Another important thing to note is that under the American's with Disabilities Act you are protected. That is, you now have on record that you are diabetic -- even if you are not diabetic you still qualify for protection under this law. Remember this if you are ever turned down for a promotion or employment in the future because some medical record says you have diabetes. The ADA law specifically states that written records of a disability cannot be considered a reason for denying opportunity, access, and employment. Unfortunately, this does not protect you from insurance companies.If there is anything I can do to help please write me off list (I am a volunteer diabetes advocacy specialist) at lahle@isletsofhope.com. Islets of Hope offers free legal advice to people in your situation through the use of volunteer attorneys. If you do nothing else, at least look into the major medical risk plan.Good luck to you.Lahle WolfeIslets of Hope
    Anonymous 42,789 Replies
    • February 12, 2007
    • 03:07 AM
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  • Hello Lahle! Thank you for all the good information! Good news from me...the doctor actually wrote a letter that I do not have diabetes!! Can you imagine? This took me over 3 weeks of research and headaches. All my work paid off. I knew the blood work did not support diabetes. The doctor that put diabetes in my records sent me a letter that makes it clear that I don't have diabetes. He still used glucose impaired, but I don't even think that applies. The letter will be appended to my records there but the diagnosis stays because it is a legal document? Not perfect, but I can honestly answer the question "have you ever been diagnosed with diabetes" NO! I have an application to the State plan. It will run me about $550.00 a month and it does not cover well care doctor visits. Not even one physical a year. The deductible is 2,500 and then another 3,000 co insurance. It is really just good for major things. I may go with a group policy for a while longer until I can secure an individual policy. There is a company call MEGA that has very bad publicity on the internet but the actual insurance looks very good. Who do you believe? At this point I almost know more than any insurance agent that I have run into here in GA. It is very sad that in this wonderful Country people can't get medical coverage. Each State has different rules and not all of them have a high risk pool. Here in GA they can rate us up 65% for medical conditions on a group plan. Kaiser turned me down on individual policy for cholesterol and blood pressure (well controlled). I'm 5'7 and 175 pounds now. Not perfect weight but not in the obese category. These insurance companies only want to take perfectly healthy people for individual policies and they get away with it. Sorry to drag on but this stuff will change your life. Erin PS...anyone know real info on MEGA Life Group Insurance - Consumer Advantage Plan? Reads good. Rates are average.
    erineb 7 Replies
    • February 13, 2007
    • 00:41 AM
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  • Hello Lahle! Thank you for all the good information! Good news from me...the doctor actually wrote a letter that I do not have diabetes!! Can you imagine? This took me over 3 weeks of research and headaches. All my work paid off. I knew the blood work did not support diabetes.The doctor that put diabetes in my records sent me a letter that makes it clear that I don't have diabetes. He still used glucose impaired, but I don't even think that applies. The letter will be appended to my records there but the diagnosis stays because it is a legal document? Not perfect, but I can honestly answer the question "have you ever been diagnosed with diabetes" NO! I have an application to the State plan. It will run me about $550.00 a month and it does not cover well care doctor visits. Not even one physical a year. The deductible is 2,500 and then another 3,000 co insurance. It is really just good for major things. I may go with a group policy for a while longer until I can secure an individual policy. There is a company call MEGA that has very bad publicity on the internet but the actual insurance looks very good. Who do you believe? At this point I almost know more than any insurance agent that I have run into here in GA. It is very sad that in this wonderful Country people can't get medical coverage. Each State has different rules and not all of them have a high risk pool. Here in GA they can rate us up 65% for medical conditions on a group plan. Kaiser turned me down on individual policy for cholesterol and blood pressure (well controlled). I'm 5'7 and 175 pounds now. Not perfect weight but not in the obese category. These insurance companies only want to take perfectly healthy people for individual policies and they get away with it. Sorry to drag on but this stuff will change your life. Erin PS...anyone know real info on MEGA Life Group Insurance - Consumer Advantage Plan? Reads good. Rates are average.
    erineb 7 Replies
    • February 13, 2007
    • 00:42 AM
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  • I'm having the same problem, except my Dr. diagnosed me with Metabolic Syndrome. I don't meet any of the criteria. I'm 5 ft tall and weigh 115lbs. My fasting blood sugar runs between 80 and 90 and my Ac1 was 5.8. I went because I had a few hairs on my neck and my blood work came back normal. She based the diagnosis on the following: I had one child 5 weeks premature that may have been considered large if he went full-term, and my mother has type 2 diabetes. My triglicerides were 130 and Cholesterol Total was 200, with an HDL of 63. My blood pressure runs 118/62. I know my cholesterol could have been better, but when the sample was taken, I wasn't fasting (and told the nurse who said they would "see how it comes out"). I had just arrived from across the country on a week-long business trip - I was eating out every meal for a week and even had steak the night before. Bottom-line - I left my job and now can't get good insurance. Anthem, the insurance I applied for is saying I'm a permenant level 4 and can only get a major medical policy (unless THIS SAME DOCTOR will say she misdiagnosed me). It has a $1,500 deductible and the cost is over $800 per month, just for me. I'm not sure what to do because I think the doctor used that diagnosis to get me on regular med-checks so she could bill the insuance. She had me on Fortamet, didn't tell me what she diagnosed me with, and didn't say anything about my cholesterol. When I went for check-ups she asked how the hair growth was going. Since she was billing the insurance and benefiting from the diagnosis, I don't think its likely she'll turn around and say it was all a big mistake. I'm only 40 and I'm really in good health. I'm afraid this will follow me the rest of my life. Can this be fixed? Can anyone help me? I don't see much on this problem on the internet.
    Anonymous 42,789 Replies Flag this Response
  • Hi there!! DON'T LET IT DROP!!!! It took me 3 months and a TON of work but I have insurance now and for only 260.00 a month!!! I did my own follow up blood work at a lab called Any Test. ALSO - My doctor was forced to write a letter saying that I did not meet the criteria for diabetes (he still implied glucose impaired). I WENT to the administrator of the medical group and pleaded my case. They called in the endocrinologist and because they never did a fasting glucose and other tests he agreed with me. You have 90 days to fax in new info to Blue Cross Georgia. They will look at the new info. GOOD NEWS!! IT sounds like you were not declined!! I was declined and then had to answer yes on all other applications until I got it straightened out. Georgia State has a plan for under $600.00 a month if you have had 18 months of coverage and it has not lapsed for more then 30 days. Call the number at the MIB - Medical Information Bureau - and get a letter with what they have on record for you. Here is the address -http://www.mib.com/html/request_your_record.html Anthem Blue Cross reports to them. MIB is a place that insurance companies report to and get reports from on people. They pay to belong and the information stays in there for 7 years. Life insurance companies use it a lot. If you have a record there it is worth fighting it there also. Assurant Health does a phone application. try them. Kaiser Permante does not pull medical records as a general rule but they turned me down based on just the fact that I''m on blood pressure and Cholesterol meds. I would be glad to talk more if you like. Email me. Erin
    erineb 7 Replies Flag this Response
  • WOW! I would really press the doctor to correct your records. I found this on the internet (see below). For my fight with the doctor I printed out as much as I could find to prove him wrong. Wrote him a letter and presented the information I found. Your thin, you don't have high A1C or high blood pressure and 200 is ok for cholesterol non fasting. Georgia is in the bottom 5 when it comes to heatlh insurance rights for an individual. Bad, Bad Bad. And in groups they have to take you but they can really raise the rates!! New York State was much better but the insurance companies pull out of NY because of it. What is the metabolic syndrome?The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:Abdominal obesity (excessive fat tissue in and around the abdomen)Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls)Elevated blood pressureInsulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)Proinflammatory state (e.g., elevated C-reactive protein in the blood)
    erineb 7 Replies Flag this Response
  • Hi there!! DON'T LET IT DROP!!!! :mad: It took me 3 months and a TON of work but I have insurance now and for only 260.00 a month!!! I did my own follow up blood work at a lab called Any Test. ALSO because of all my research and letter writing my doctor was forced to write a letter saying that I did not meet the criteria for diabetes (he still implied glucose impaired). I went to the administrator of the medical group he worked with and pleaded my case. They called in the endocrinologist. Considering the fact that the test results were not high enough to support diabetes and the doctor never told me or treated me for diabetes they asked him to write a letter correcting the diagnosis. If he didn’t I think they felt I had a case for a law suit. He should have at least told me he diagnosed me with diabetes and treated me for it if I had it. Few things to do – Call the MIB and request a copy of your record. http://www.mib.com/html/request_your_record.html Medical Information Bureau is a place that insurance companies report to when they get information on someone that others might want to know. Other insurance companies pay to get reports. Information stays on file there for 7 years. Mine was empty. Get a copy of your medical file from the doctor to see how bad she screwed you. I honestly cried on the phone with my doctor telling him he wrote me a death sentence! I was so upset!! See what she wrote and what the actual tests show. Research your condition and write a letter to the doctor requesting that your records be amended. Present your case with information you gathered. HIPAA laws require the doctor to put a copy of your request to amend records in your record. Call the doctors office and request to talk to the HIPAA Privacy Officer. Let them know you want a form to request a change to your medical records. This makes them nervous. They all have to be HIPAA compliant. If they are not it can be a mess for them. I knew more about HIPAA than the records department at the doctors. Armed with my own blood test results, a well written letter by me of why I think I was misdiagnosed and the short note from the doctor saying I did not meet the criteria I was reconsidered and accepted for the policy. You can email me for more info if you like. I think you can email me through here since I’m a registered user. I don’t want to be too lengthy. Or post me your email address. Erin :o
    erineb 7 Replies Flag this Response
  • Thanks for the information. I need all I can get to fight this. I have two young children and I'm trying to start my own business. Instead of working to make money to pay the outrageous insurance (you know the insurance companies know the deal - they are just paying me back because they were screwed by the Doctor on my behalf); I'm just working on trying not to go broke before I get this fixed. I know what you mean - I cried too when the Anthem rep told me I was a permenant level 4. I found on the internet last night that insurance companies are required to provide an adverse action letter. That's one thing they didn't do. I didn't know my rights so I didn't appeal within the 90 days.I went back to the doctor in January armed with the evidence to plead my case. Since it was a pre-existing condition, I paid $600+ for the lab work and another $100 to see the doctor. I ended up seeing the nurse practitioner who agreed with me that I didn't have metabolic disorder. She said she would put something in my file saying that. I called to get my medical records from the office - to see what was really there - and guess what? Nothing in the file about my visit and our discussion and now the Nurse Practitioner is gone. I've called several times and the receptionists give me the runaround. They say I need to talk to the Practice Manager, but she won't call me back. I tracked down the Nurse Practitioner at another practice and she DID call me today, I just missed her call because she didn't use my cell phone. I told the receptionist today that I will give them a few days to call back or I will start "dropping by" the office, even though it's an hour away from me. That tactic usually works - if they don't want to talk to you on the phone, they really don't want to see you in person. I wish I had known about the medical information sharing from the link you shared. I don't understand how they can do that with HIPPA. I had also applied for Life Insurance. Before I realized it was a problem, I didn't bother saying I went to that doctor. At the time, I didn't even know I had a diagnosis on file there. I'm sure the Life Insurance company thinks I'm a crook now. Also, when I had the Life Insurance medical exam, my fasting (only 4 hours) blood sugar was lower - about 50 and my Cholesterol was 266. I think anxiety about taking the tests may be causing the Cholesterol to be higher. I read about it being influenced by stress. Very strange since I stopped most dairy and almost all red meat in January. Honestly, I'm afraid to have any tests now because I don't want anyone to find anything wrong with me until I can get this fixed. I need to go to the Gyn for a Pap and get a mamogram, but I'm really afraid because Cancer is what gets everyone in my family - not heart disease. I only have a $1 million lifetime limit. Again, thanks for the information. It's nice to talk to someone who knows what I'm talking about and understands the frustration.
    Anonymous 42,789 Replies Flag this Response
  • Just please remember Erin - while you have won the battle, you still need to exercise. Exercise is not something that is just a "good idea". It is a vital part of keeping your body in one piece. If you don't resistance train now, you may live to an old age, but you'll have to have someone help you move about. And a good program, with 30 minutes of resistance training, 10 minutes of interval cardio and 5 minutes of stretching, takes 45 minutes, getting you in and out of the gym in 1 hour, 3 times a week. Well worth it, especially to lower your insurance.
    Anonymous 42,789 Replies
    • January 20, 2008
    • 02:33 AM
    • 0
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  • My doctor wrote the word Diabetes in my chart before I left to move to GA. Now I can't get health insurance here. My FGP tests have all been normal. He did not tell me I had diabetes. When I called him about it he said I don't need any diet changes or treatment. He based my diagnosis on one A1C test that was 6.1. Everything I have read says A1C is to monitor diabetics and not to diagnose it!! Anyone know how I can fight this?There are programs to help people with no health insurance...GO TO THE HOSPITALDiabetes
    davidlee 9 Replies
    • January 23, 2008
    • 06:56 AM
    • 0
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  • i had a false diagnosis of flibra myalga. the dr was a d.0 rheumatolgist. he was on my old insurance plan. he over medicated me i gained over 30 lbs i am only 5'2. i had to be detoxed because one was addicting. i have not had the diagnosis since 2001. i have repeatly been turned down for insurance.i am going to have to apply for a county plan. is there any way to get this diagnosis erased so i can get decent insurance?
    Anonymous 42,789 Replies
    • September 12, 2009
    • 08:51 PM
    • 0
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  • I did get my wrong diagnosis reversed!! They can't take it out of your record but they added a letter to mine from the doctor correcting his diagnosis. I had to call and write to the administrator of his medical office and explain that there was no test done for diabetes, no diet perscribed, and the sugar levels were low and within margin of error. It took me a long time and hard work. The bottom line is that I could have sued them for not treating diabetes if I really had it! Keep doing research and writing letters! They have no idea how they can ruin peoples chances for getting insurance.
    Anonymous 42,789 Replies
    • September 13, 2009
    • 00:40 PM
    • 0
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  • I was just denied for a health insurance coverage due to elevated cholesterol and fasting blood sugar. I had my lab work done in a community clinic from where i get my depot/injectable. I was advised by the doctor administering the shot to have a blood work which I did. The results came my total cholesterol was 235 and 104 fasting blood sugar. What I just disclosed in my application is regarding my cholesterol and did not mention regarding my blood sugar since it is not considered an issue, though I was just in the borderline. They asked the number of the doctor which gave me the lab result. Got frustrated when I got the denial letter stating the reason why with additional comment from the doctor that I was advised to see a doctor regarding abnormal lab work. How can I see a doctor if I still have no insurance yet? I've talked to one of the insurance agent asking her If I could still get an insurance after being denied. She told me that since I was advised to see a doctor and still have done yet, that made them automatically declined my application. She advised me to have the lab test be interpreted by my doctor. Other agent told me not to go to doctor yet coz it might just aggravate my case if the doctor will prescribe medication.Please advise me if I have to see the doctor first before trying other insurance companies. I was thinking what if the doctor might not see my case that worst and will just advise to do some diet. My doctor might ruled out that my blood sugar level should not be an issue since 104 is not considered diabetes? Hope you can enlighten me on this. I am having sleepless nights being ininsured and can't afford state insurance.
    mcalemana 1 Replies Flag this Response
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