Does insurance have access to visit notes? Also how is medical necessity determined?
A couple of weeks ago I met with a plastic surgeon to discuss scar revision options for a surgical incision site that has been bothering me. I’ve noticed some inaccuracies in the visit notes and am debating if it’s worth reaching out and asking them to amend the records. I know that it’s incredibly common for visit notes to have errors (and these are not even the worst ones I’ve seen), but I’m also aware that there’s a risk of being labeled a “problem patient” if you complain/nitpick too much and some providers are reluctant to alter the notes at all even when it’s a correction.
The first is after listing the surgical and non-surgical options we discussed, it says “following our discussion, she is not interested in the aforementioned nonsurgical modalities to soften her current scar tissue.” The reality is, I have been already trying scar tissue massage and silicone sheets for months (which I told him) and the surgeon himself advised me that this particular scar is not a good candidate for steroid injections because of the type/location.
Later in the notes it says “she denies any pain at the site but does note feelings of tightness” when they never even asked me about pain. I’m sure I probably used language like “tight” and “uncomfortable” when describing it but it absolutely does cause me pain.
Part of me feels like I’m just arguing semantics and getting hung up on details but another part of me is afraid that these are going to come back to haunt me if I do end up moving forward with surgery and need to get insurance to cover it. I don’t want to seem like I’m unwilling to try less invasive approaches or that it’s not affecting my quality of life enough to justify surgery. Do these things make it worth the trouble of advocating for the notes to be changed? What factors do insurance companies look at when deciding if a plastic surgery procedure will be covered as medically necessary?
For the record, I live in Michigan and have an individual HMO plan through Priority Health.
submitted by /u/1001tealeaves
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