[Doctors talk freely. Painted Benevolence]Suspicious Clouds of Medical Insurance: Case (1)

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I still remember that about seven or eight years ago, when I was working in a private medical center, I did some research on the insurance industry in the medical field, and then wrote several insurance-related articles to share with readers.

Many years have passed in a blink of an eye, and many changes have taken place in the medical insurance industry. I have also gained some new feelings and experiences in the process of interacting with insurance companies and patients. I would like to share it with readers again.

It is difficult to write a report without follow-up treatment

One afternoon, when I was still busy in the clinic, the outpatient lady suddenly received a call from a woman, saying that she had something very important to contact me, and she transferred the call to my room after a while.

“Ms. Chen, hello, what can I do?” I asked.

“Hello, Doctor Huang, I’m calling this time to ask you to do me a favor.” Ms. Chen said.

“Excuse me, what can I do for you?” I asked.

“I would like to ask you to help me write a ‘favorable medical report’ (favorable medical report), which states that my high blood pressure has completely returned to normal and is under control, and I do not need to take any high blood pressure drugs. I am currently applying for a new However, because it discovered that I had been admitted to your hospital for hypertensive emergencies more than 5 years ago and was treated by you at that time, it now requires me to show a certificate saying that I have no high blood pressure and am in good condition. With such a report, it will allow my application to be approved.” Ms. Chen said.

“Then Miss Chen, I want to have a look at your medical records before I can tell you if there is a way to write this favorable medical report.” I replied.

As a result, after reading her medical records, it was found that this Ms. Chen did have a medical record more than 5 years ago. The reason for the hospitalization was that the blood pressure was too high (the systolic blood pressure was as high as 220 mmHg and could not be controlled), and it was accompanied by dizziness and headache. He was hospitalized as a last resort and took high doses of antihypertensive drugs for two days before the blood pressure returned to normal.

But the problem is, after she was discharged from the hospital, she never came back to the outpatient clinic for follow-up treatment, which means that how has this Ms. Chen’s blood pressure been controlled in the past 5 years? I don’t have any clues. To put it bluntly, I can’t write this medical report. If I write it, it will be “broken” and suspected of “fraud”.

“Miss Chen, I want to know whether you have continued to seek medical treatment for your high blood pressure in the past five years or so?” I asked curiously.

Reports containing fraudulent elements are voided

“Dr. Huang, in fact, I occasionally go to see a doctor outside the hospital, but most of the time I use diet and exercise to control my blood pressure. I measure my blood pressure at home and the index is almost normal, so I think my blood pressure is normal. My high blood pressure has gone away, and I haven’t taken any high blood pressure medicine in the past few years.” Ms. Chen said.

“Miss Chen, because I haven’t tracked your condition for more than 5 years, I suggest that you should go to the doctor you have seen in the past 5 years, and let him write this medical report to prove that your blood pressure is stable now. It would be more reasonable to take high blood pressure medicine again!” I replied.

“Oh, Dr. Huang, don’t worry about it so much. You just need to write a report stating that my blood pressure has been normal for more than 5 years. I don’t need to take any medicines. I can buy medical insurance and guarantee blood pressure-related medical insurance. The disease will be fine, but you must know that if it weren’t for your medical records, I would not be able to buy medical insurance until now!” She said with a bit of complaint.

“Miss Chen, because I have no record of your follow-up treatment in the past 5 years, so I really can’t help you this time, please find another doctor!” I said firmly.

Indeed, writing this kind of medical report contains elements of “fraud” and should not be written. The insurance company is not a fuel-efficient lamp. If it is discovered, the patient’s insurance will be invalidated, and the doctor who wrote the report will be blacklisted by the insurance company and cannot treat the insurance company’s customers. This kind of loss may be difficult to estimate.

Guangming Daily/Doctor Column‧Author: Huang Xueqian)

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