Question

When Ruth applied for health insurance, she listed a colonoscopy examination as part of her medical history. The insurance company asked for more information. Ruth requested, in writing, that the clinic where she had been examined send only the colonoscopy records to her insurance company. In addition to the requested information on her colonoscopy, the clinic sent all of Ruth's medical records for the past five years, which included the diagnoses of fibrocystic breast disease and obesity. As a result, the insurance company issued Ruth a policy, but attached riders stipulating that it would not pay for any illnesses arising from the fibrocystic breast disease or obesity.

Ruth complained to the clinic administrator, explaining that she had requested that only those records concerning her colonoscopy be forwarded to the insurance company. The administrator apologized and assured Ruth that the clinic's policy concerning release of medical records would be reviewed. He also told Ruth that should she ever incur medical expenses for those conditions excepted in her insurance policy, she should contact him.

A. Did the clinic err in sending all of Ruth's medical records to the insurance company? Why or why not?

B. did Ruth have a legal cause for action against the clinic? Explain.

C. What would you do, in the clinic administrator’s place, to rectify the situation and make sure that similar problems did not arise in the future? Explain.

Answer 1

Answer A: The clinic err in sending all of Ruth's medical records to the insurance company because the records that has been requested only that should be forwarded. The insurance company asked to forward the medical information that is related to the colonoscopy but the clinic send all the information and this is the err the clinic did.

Answer B: The client has a legal cause for the action that has been done by the clinic staff as due to their negligence, the rejection of claims occurs. This lead hurdle in promotion of Ruth. The 4 D's of negligence includes:

1.Duty

2.Direlict

3. Damages

4.Direct cause

Answer C: To rectify the situation, it is important that this err should not be repeated. The course of action should be taken and strict rules should be made. The clinical documents should be revised and maintained. To rectify the error, the clinical staff should have prepared the diagnosis report of the Colonoscopy.