The Shoulder
The Shoulder
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Insurancebrave-finch-269

Insurance keeps claiming they never got my medical records — been going on for months now

I'm losing my mind a little bit here and just need to know if anyone else has dealt with this.

I was rear-ended back in the spring — not a dramatic accident, but my neck was bothering me enough that I went to urgent care twice and did a few PT sessions. Nothing crazy. The other driver's insurance accepted liability pretty quickly which honestly made me feel like this would be simple.

Wrong.

I submitted my medical bills and visit summaries to the insurance company. They acknowledged receipt, said everything looked fine, told me to expect reimbursement. Cool. Except then the PT clinic started texting me about an unpaid balance. I called the insurer and they said — and I quote — "we haven't received the medical records for that visit."

Okay. I re-sent everything. Got confirmation they received the new batch. Two weeks later, same story. "We still don't have the medical records." I asked them to tell me specifically what was missing. They couldn't (or wouldn't) tell me. Just kept repeating the phrase "medical records" like a robot.

I looped in the PT clinic. Their billing coordinator told me they'd already faxed the records three times. Three. And the urgent care office told me the same — they have confirmation receipts showing the insurer's fax line accepted the documents.

So someone is either losing paperwork on purpose or their internal system is a black hole. Meanwhile my credit could take a hit if this bill goes to collections.

Has anyone gotten through this kind of runaround? What actually worked for you?

12replies

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12 replies

  • 17
    silent-otter-297

    Oh wow, this is almost exactly what happened to me after my accident last year. The insurer kept saying they didn't have 'complete' records but refused to say what was incomplete. What finally broke the logjam for me was sending everything via certified mail AND emailing it so I had timestamps on both ends. When I could say 'I have proof this was delivered on this date,' the conversation shifted pretty fast. Doesn't explain why they keep losing things, but having that paper trail seemed to embarrass them into actually processing it.

    • 15
      kind-fox-276

      I used to work on the claims side and I'll be real with you — sometimes this is a genuine system issue where faxes land in a queue nobody monitors. But sometimes adjusters use 'missing records' as a stall because there are internal cycle times they're trying to hit. Either way, the fix is the same: stop faxing. Email directly to your adjuster's address, CC their supervisor if you can get that name, and reference your claim number in the subject line every single time. That creates a trail that's very hard for them to ignore or misplace.

    • 11
      genuine-owl-163

      Just a heads up from a medical side of things — make sure you've authorized a full release of records with both the urgent care and the PT clinic, not just the billing summary. Sometimes insurers technically distinguish between the itemized bill and the actual clinical notes, and they may want both. It's annoying because for a straightforward injury claim you'd think the bill would be enough, but I've seen this trip people up. Worth a quick call to both providers to confirm what exactly was sent.

    • 4
      plainspoken-late-shift663

      Exactly my experience. Persistence paid off in the end.

  • 15
    bold-badger-631

    They know exactly what they're doing. Delay, delay, delay — hoping you get frustrated and settle for less, or that the provider writes it off. Don't let them wear you down. Document every call: date, time, rep's name or ID number, and what they said. That log becomes really useful if this ever escalates.

  • 22
    bold-kestrel-343

    A couple of practical things worth knowing: first, you can file a complaint with your state's Department of Insurance if an insurer is engaging in unreasonable claims delays — most states have specific timelines insurers are legally required to follow. Second, ask the insurer in writing (email is fine) to identify the exact records they need in a formal written response. Forcing them to put it in writing changes the dynamic. They can't keep vague-ing you out if there's a written record of the specific ask.

  • 6
    mellow-newt-022

    Call the PT clinic's billing department and ask them to send you the fax confirmation receipts directly. Then send those receipts to the insurance company and say 'here is proof your system received these documents on these dates.' Put the burden back on them to explain what happened after the fax landed. If they still can't process it after that, escalate to their claims supervisor in writing.

  • 5
    kind-hare-561

    This sounds so stressful, especially when you did everything right and you're still getting dinged for it. The fact that the PT clinic has fax confirmations is actually huge — you're not just taking your own word for it. I really hope you get this resolved before it hits your credit. Hang in there.

    • 5
      clear-tern-789

      Quick question — is the insurer here the other driver's liability carrier or your own? Because the process and your leverage is pretty different depending on which one you're dealing with. Also, did you sign a medical records release authorization form for the insurer directly? Sometimes that's a separate step people miss and it can cause exactly this kind of back-and-forth.

    • 0
      grounded-sidewalk415

      Thank you both, this gave me the push I needed to make the call.

  • 8
    silent-lynx-523

    Not legal advice, but this pattern — repeated claims of missing documentation despite confirmed delivery — is something attorneys who handle these cases recognize. If the provider's balance goes to collections while this is unresolved, that's a separate problem that can follow you even if the underlying dispute gets sorted out later. Might be worth a free consultation with a PI attorney just to understand your options, especially if the insurer keeps stonewalling. Many will talk to you at no cost.

    • 0
      weary-dreamer869

      Same boat here. Did anyone mention a deadline to watch out for?