Note:
I am updating this in 2015. When I originally wrote this report back in 2003, I
did not name the doctor
who caused all the problems. Below, I have named him, Dr. Mark Lynn Nichols,
Houston ENT L.L.P.
Also,
the insurance companies mentioned below probably no longer exist. I have lived
out of
the US for over 10 years now, and I am very happy that I don't have to deal with
Obama's "health care" brainchild. But if you do, some of the
information
below regarding insurance companies has probably changed.
These days health insurance is expensive and difficult to obtain. At the conclusion of EACH visit to a doctor, be SURE to review what he/she plans to put in your medical record - and make the doctor change it if there is an error, or if the doctor does not clearly explain a condition. Also, beware about mentioning any previous medical history that is not specifically significant to the reason you are consulting this particular doctor.
Our insurance agent said doctors' records are a big problem today in the reason people are denied health insurance. As one example, she related an incident that happened to her. She said that during a visit to one doctor, she mentioned that in a blood analysis done previously by another doctor, her liver enzymes had been slightly elevated. Being savvy about these matters, our agent asked to review what the doctor had written about her current visit. He had written that she had hepatitis! This wasn't true, and she made the doctor change his records before she left the office. If this had become part of her permanent medical record, she would have been labeled as having had hepatitis no matter how much she protested the error. These are the sad facts today.
The problem with doctors’ records can also affect the ability to buy long-term health care. A test on a friend indicated he might have a heart condition. A subsequent test (by a second doctor) showed that my friend’s heart is perfect and that the previous test was an incorrect indication. In fact, the new doctor said my friend would die of being hit by a truck before he’d die of a heart problem. But because of the first test, he was unable to qualify for long-term care insurance. Trying to correct the error, they wrote several letters to the first doctor, to no avail.
This is what happened to my husband Harry and me:
The misleading and incomplete records by Dr. Mark Lynn Nichols, Houston ENT L.L.P were the direct cause of my husband being denied health insurance under my health policy with World Insurance. It was only after a lot of detective work that I discovered this doctor's records were the problem. Because private health insurance is so expensive and difficult to obtain these days, I hope to help other people avoid the same problem. That's why I devoted this page to caution people to ask what a doctor has written in his records before you leave the office, and make them change anything that is incorrect or misleading.
Background:
Dr. Mark Lynn Nichols, Houston ENT, L.L.P., had performed a surgical procedure for sleep apnea on my husband, who had a COBRA policy at the time. He did not plan to resume work as an employee, only as a consultant. We submitted an application to include him on my health policy.
My husband and I are both extremely healthy, and we were shocked that his application was denied. It was Catch-22 trying to find out why. They wouldn’t tell us, except that the denial was based on medical records. He could only get health insurance through a Texas "pool," which would have cost him alone about $750 per month at the time.
We went through 10 months of detective work and hassles and frustration and emotional distress trying to find out the reason. Finally, I started researching other health plans. I eventually found an agent whom I considered excellent. She had a plan with Unicare that would suffice, although the plan is inferior to my policy for which my husband was denied coverage. She said that since my husband had already been turned down by one insurance company, getting an application approved by another would be more difficult. She said we needed to obtain all of his medical records and review them for errors.
After we obtained the doctor's records on my husband, two errors immediately became clear why my insurance company had denied coverage to my husband. (1) Dr. Nichols had not even (in his records anyway) released my husband from post-op care. Because the doctor's had not formally released him in his written records, which were sent to the insurance company, they assumed the conditions for which the doctor performed surgery still existed, or at least might require additional surgery. (2) In the initial interview while being asked the normal questions, Harry remarked that he hadn't drank alcohol in 20 years. As we found out later, Dr. Nichols wrote in his records that Harry was an alcoholic.
We had gone through 10 months of work and emotional distress because of of Dr. Nichols' failure to complete his records on my husband and because he falsely diagnosed my husband as "an alcoholic."
Our insurance agent said because of Dr. Nichols' records, submitting an application to another company would be fruitless. She said the risk pool was the only alternative, which would have cost us at least $30,000 extra in premiums alone until he is eligible for medicare.
I thought if I explained the problem to Dr. Nichols, he would be happy to clarify his records--and also complete them to indicate he had released Harry post-surgery. I was dismayed at his arrogant refusal to do any of it.
I persisted and persisted. I had asked him very nicely, but in the last fax to him I threatened to complain to his licensing boards. And I told him I had put the story of this unconscionable situation on my web site. After that, he wrote a very brief letter of partial clarification. This was, of course, too little and too late for getting my husband insurance with my company. By then they had turned down the several appeals we had made and it was a closed issue as far as that company was concerned.
Our insurance agent said that although the letter far from addressed everything, it at least offered the Unicare underwriters the ability to give weight to our letter clarifying the rest of Dr. Nichols' records that we intended to include with the application. Also, on the application to Unicare, in answer to the question about why my husband had been turned down by World Insurance, the agent advised my husband to write "the misleading records of Dr. Mark Lynn Nichols."
Only because the doctor did finally write the very brief letter, the underwriters could then give weight to our letter. (Otherwise, according to our agent, they would have not listened to any explanation whatsoever.)
So, after much detective work and effort, we finally obtained a health policy for my husband, although the policy is inferior to mine regarding prescription coverage and has a $2,000 deductible instead of the $1,000 deductible I have. Because of all the hassles with the medical records, we also had to cancel--at the last minute--a trip to Mexico that we had been planning for a couple of months.
I don’t think the doctor singled out my husband to cause problems for. And if I hadn't had both the tenacity and the writing skills necessary to overcome obstacles like he put in our path, my husband would have been in the risk pool. So in July I filed a complaint with the doctor's licensing boards. I explained the problems that he caused us, and demanded that he be taught how to properly write his records. It was my hope that other people would not have to go through the nightmare that we did – or worse, not know how to do the “detective work” and end up having to use the risk pool.....or worse still, not be able to afford the high cost of the risk pool and have no insurance at all.
Shortly after I filed the complaint, the doctor filed a harassment suit of libel, slander, and business disparagement against both of us. It’s an alarming situation when a person can’t file a legitimate complaint about a doctor without fear of being sued. If doctors are allowed to get away with actions like this, the problem will only get worse.
By the way, a July 2002 article in the Houston Chronicle says our State Medical Board hasn't removed a single bad doctor in five years. It seems to me that there's a glaring conflict of interest: the Board consists of 18 members, 12 of whom are doctors. This indicates that they "circle the wagons" to protect their own. If the Medical Board doesn't remove doctors who have committed serious infractions, that seems to indicate that they won't do anything about "simple" medical record inaccuracies - even though errors with medical records can cause horrible problems to patients. (Indeed, the only response I received from the Medical Board was a letter dismissing my complaint.)