Marshal Mo Hare, SASS #45984 Posted October 27, 2021 Share Posted October 27, 2021 Many years ago my late wife, Linda, aka The Germinator, was a PT, physical therapist. On the same day she got two patients for whom the insurance companies wanted a second opinion about their disabilities. I will avoid ethnic references, and I think after this length of time HIPAA regulations do not apply. patient #1, bad back. Examination showed all the right symptoms. After the exam, as per protocol, Linda accompanied the patient to the front desk at which time patient saw his son in the waiting room, lifted said son and tossed him to the ceiling and caught him. Of course, such an observation goes into the report. patient #2, also bad back, debilitating injury. Examination did not disagree, but the insurance company made a mistake that would be fitting for a soap opera. Patient’s medical file included the report of a private detective. “X was observed sneaking out the back of his home and going to a convenience store to buy scratch lottery tickets.” As I recall X went to a few other stores to buy ticket also before sneaking back to his home. Link to comment Share on other sites More sharing options...
Singin' Sue 71615 Posted October 27, 2021 Share Posted October 27, 2021 5 hours ago, Marshal Mo Hare, SASS #45984 said: Many years ago my late wife, Linda, aka The Germinator, was a PT, physical therapist. On the same day she got two patients for whom the insurance companies wanted a second opinion about their disabilities. I will avoid ethnic references, and I think after this length of time HIPAA regulations do not apply. patient #1, bad back. Examination showed all the right symptoms. After the exam, as per protocol, Linda accompanied the patient to the front desk at which time patient saw his son in the waiting room, lifted said son and tossed him to the ceiling and caught him. Of course, such an observation goes into the report. patient #2, also bad back, debilitating injury. Examination did not disagree, but the insurance company made a mistake that would be fitting for a soap opera. Patient’s medical file included the report of a private detective. “X was observed sneaking out the back of his home and going to a convenience store to buy scratch lottery tickets.” As I recall X went to a few other stores to buy ticket also before sneaking back to his home. You lost me on the X Link to comment Share on other sites More sharing options...
Marshal Mo Hare, SASS #45984 Posted October 27, 2021 Author Share Posted October 27, 2021 20 minutes ago, Singin' Sue 71615 said: You lost me on the X I could have said “John” as a nice anonymous name. Link to comment Share on other sites More sharing options...
Alpo Posted October 27, 2021 Share Posted October 27, 2021 I understood the X. I just can't find the mistake. They had a private detective checking on him? That was the mistake? If it's a big enough insurance claim, I thought having a private detective tailing him was normal. I damaged my leg and was out of work for 3 weeks. Probably cost the insurance company less than three grand in wages, and maybe another 25 or 30k in medical bills. Big whoop. But if I damaged my back, and could never walk or work again, and needed a 15 million dollar settlement -yeah they would do some investigating. Link to comment Share on other sites More sharing options...
Singin' Sue 71615 Posted October 27, 2021 Share Posted October 27, 2021 Yup...the second scenerio is lacking information. Link to comment Share on other sites More sharing options...
Marshal Mo Hare, SASS #45984 Posted October 27, 2021 Author Share Posted October 27, 2021 16 minutes ago, Alpo said: I understood the X. I just can't find the mistake. They had a private detective checking on him? That was the mistake? If it's a big enough insurance claim, I thought having a private detective tailing him was normal. I damaged my leg and was out of work for 3 weeks. Probably cost the insurance company less than three grand in wages, and maybe another 25 or 30k in medical bills. Big whoop. But if I damaged my back, and could never walk or work again, and needed a 15 million dollar settlement -yeah they would do some investigating. The mistake there was the fact that the ins. Co. Included the PI report with the medical file when they sent it for an evaluation by a PT. All things should be kept separate. Link to comment Share on other sites More sharing options...
Eyesa Horg Posted October 27, 2021 Share Posted October 27, 2021 One of the guys that worked for me in the phone company was out for 6 months due to a rotator cuff surgery. Just before he was to return the Doctor gave him a slip for a few more months. When I checked up on him one day, which apparently wasn't legal, he was running a "Painting business" on the side! The union kept his job for him as I was "harassing" him while he was out sick. Go figure. Link to comment Share on other sites More sharing options...
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