HIPAA Vent.

[DawnCt1]

Let me preface this to say that I think that insurance companies are using HIPAA to avoid answering a direct question. Short version of a long story.
DS 20 has had extensive dental care ($17,000) due to congenitally missing teeth. All that work has recently been completed by a prosthedontist who is at the top of his field. (Dental professor, Tufts), so he is off of every insurance companies dental plan. However, we do get reimbursed for up the the limits of the plan. DH has Plan #1. They have reimbursed, sent me the EOB's etc. I Cobra'd my dental plan from my job, knowing that this big bill was coming and it was more than worth it. EOB from #1 plan gets sent to #2 plan. I call to see if the claim is being processed but they can't "talk to me without DS's permission because of HIPAA". They are not health care providers, they send ME an EOB whenever they pay out a claim. I told her that I felt that she was misinterpreting HIPAA and that I am not asking for any medical or dental information just the bottom line; "is the claim being processed and will the check be in the mail". After 5 minutes, the answer is "yes". I ended my conversation with, "I want to know if I can expect a check, you indicated that I can so do you need permission from my DS to talk to me"? Her answer? No. Now why did it have to be that complicated?

 

[Tigger_Magic]

Probably because of HIPAA security rules. The big thing is to protect healthcare information from accidential or intended disclosure that might violate the insured's rights under HIPAA. Some people, being overly cautious, are going to err on the side of "protection" and be very reluctant to disclose anything.

I don't remember the exact penalties for an illegal disclosure, but it's thousands in fines and possible jail time. That was drilled into us last March in our HIPAA security training. Scared the jimmies out of some people.

 

[AllyandJack]

I recently had a conversation with the stupidest person on the planet at Blue Cross. It ended with me asking her if "Dumb (insert word that rhymes with witch here)" is a section on the employment application or if she just puts it under special skills.

It is a requirement that it be that complicated. Somewhere, in all their training, there is a special day devoted to "Driving The Patient Crazy Until They No Longer Want Us To Pay".

 

[Cindy's Mom]

I recently had a conversation with the stupidest person on the planet at Blue Cross. It ended with me asking her if "Dumb (insert word that rhymes with witch here)" is a section on the employment application or if she just puts it under special skills. .

Do you mind if I use this classic quote in the future. I betcha, I will have said it to someone today before the day is over!!

 

[disneysteve]

Sorry Dawn, but if your son is over 18 you do not have the legal right to his medical OR financial information without his consent. In this situation, I think the insurance company was correct in denying you that information.

Of course, the whole situation is rather ludicrous because I could have called, said I was your son, and gotten the info with no trouble. And if you were calling about a daughter instead of a son, you could have just claimed to be her and would have gotten no argument. So the system is not at all secure.

 

[mickeyboat]

Let me preface this to say that I think that insurance companies are using HIPAA to avoid answering a direct question. Short version of a long story.
DS 20 has had extensive dental care ($17,000) due to congenitally missing teeth. All that work has recently been completed by a prosthedontist who is at the top of his field. (Dental professor, Tufts), so he is off of every insurance companies dental plan. However, we do get reimbursed for up the the limits of the plan. DH has Plan #1. They have reimbursed, sent me the EOB's etc. I Cobra'd my dental plan from my job, knowing that this big bill was coming and it was more than worth it. EOB from #1 plan gets sent to #2 plan. I call to see if the claim is being processed but they can't "talk to me without DS's permission because of HIPAA". They are not health care providers, they send ME an EOB whenever they pay out a claim. I told her that I felt that she was misinterpreting HIPAA and that I am not asking for any medical or dental information just the bottom line; "is the claim being processed and will the check be in the mail". After 5 minutes, the answer is "yes". I ended my conversation with, "I want to know if I can expect a check, you indicated that I can so do you need permission from my DS to talk to me"? Her answer? No. Now why did it have to be that complicated?

I am not HIPAA certified, but we ran into some HIPAA issues with our last insurance renewal. Our agent told us (again, I don't know if it is true) that HIPAA rules are different when the objective is to get a claim paid.

And, I do think insurance companies do use HIPAA as an excuse not to talk to someone, and they do err on the side of caution.

Denae

 

[AllyandJack]

DH and I repeatedly call Blue Cross for each other. It all depends on which one of us can stand to talk to them on that particular day. They never have a problem talking to me about something to do with DH and they never complain when DH calls to ask about something related to me. I doubt they'd give out specific medical information, but information about a plan or a claim....they always answer questions (not that they're right, but they give an answer anyway).

Cindy's Mom - Feel free to use that lovely phrase.

BTW: The reason I lost my temper with that woman is because I asked to speak to a supervisor and she put me on hold, came back, and said, "I spoke with him and he agrees with me."

 

[disneysteve]

DH and I repeatedly call Blue Cross for each other.They never have a problem talking to me about something to do with DH and they never complain when DH calls to ask about something related to me.

Now that you mention it, I'm always the one that calls the insurance company when there is a question. As long as I've got all the info - claim number, policy number, SSN, they have never questioned who I was.

So maybe HIPAA doesn't cover this. I'm no HIPAA expert honestly.

 

[jfulcer]

It ended with me asking her if "Dumb (insert word that rhymes with witch here)" is a section on the employment application or if she just puts it under special skills.

Boy, you sure did show her. I'm sure you'd feel about as small if someone called you the same thing at your job when you think you're trying to do your best. I'm sorry, but having worked at an insurance company and knowing what grief our call center took because of our out-dated systems and weird contract rules that may have made them look less than helpful, I tend to give anyone in this position the benefit of the doubt.

Dawn - I'm sorry that this upset you. I'd suggest that you get call back and ask for an authorization form for access to your son's record. I would assume that once he turned 18, the rules for access to his records changed - even if you are paying the bills. You should also so the same thing for his doctor - it's possible (not likely, but...) they can deny you access to his records also. My wife has to deal with HIPAA regs all the time at the hospital she works at. The hospital is overly cautious because they don't want to pay the extensive fines.

 

[jfulcer]

BTW: The reason I lost my temper with that woman is because I asked to speak to a supervisor and she put me on hold, came back, and said, "I spoke with him and he agrees with me."

Oh, I see, that's what gave you permission to call names....

 

[AllyandJack]

Boy, you sure did show her. I'm sure you'd feel about as small if someone called you the same thing at your job when you think you're trying to do your best. I'm sorry, but having worked at an insurance company and knowing what grief our call center took because of our out-dated systems and weird contract rules that may have made them look less than helpful, I tend to give anyone in this position the benefit of the doubt.

Well, when someone gives you erroneous information that holds up your medical treatment and refuses to let you speak to a supervisor, then you can compliment them. Once my doctor called, a supervisor called me back and apologized for the erroneous information that this woman repeatedly gave me during our 45 minute conversation. If she HAD spoken to a supervisor, she would have realized she was wrong.

 

[ChrisnSteph]

Personally, with all the obscene amounts of paperwork it requires, I think HIPPA is just a secret plot to thin the forest.

 

[Trish5768]

Don't think thats its just insurance companies who are doing this. My DS18 was admitted to the hospital with a burst appendix. He was very sick, we almost lost him. The hospital staff did not seem to think my DH and I were entitled to any info about his condition or care. Seems that once you are 18 they won't tell anyone anything without consent even if you are the person carrying the insurance/paying the bill.

I actually asked a nurse what was going on with him and she kinda did a head roll towards DS and told me to ask him. I could not believe what I was hearing. DS was so out of it from his morphine that I'm sure he could not even tell me his name.

I went home typed a letter up giving DH and I permission to be updated on his condition and had to wait until he was able to sign it. Once he did, I took it directly to the nurses station and had them put it in his chart. I got info after that but I have to tell you I was completely ticked off by the whole series of events. I feel like we are the parents, we are carrying the insurance and this is still my child living under my roof, and I deserved some answers. I could understand this if he was 26 living on his own but not when hes still a dependent.

 

[AllyandJack]

Don't think thats its just insurance companies who are doing this. My DS18 was admitted to the hospital with a burst appendix. He was very sick, we almost lost him. The hospital staff did not seem to think my DH and I were entitled to any info about his condition or care. Seems that once you are 18 they won't tell anyone anything without consent even if you are the person carrying the insurance/paying the bill.

I actually asked a nurse what was going on with him and she kinda did a head roll towards DS and told me to ask him. I could not believe what I was hearing. DS was so out of it from his morphine that I'm sure he could not even tell me his name.

I went home typed a letter up giving DH and I permission to be updated on his condition and had to wait until he was able to sign it. Once he did, I took it directly to the nurses station and had them put it in his chart. I got info after that but I have to tell you I was completely ticked off by the whole series of events. I feel like we are the parents, we are carrying the insurance and this is still my child living under my roof, and I deserved some answers. I could understand this if he was 26 living on his own but not when hes still a dependent.

So, what if a spouse is in an accident? Or a parent?? How does a family member get information?

 

[Tigger_Magic]

Well, when someone gives you erroneous information that holds up your medical treatment and refuses to let you speak to a supervisor, then you can compliment them. Once my doctor called, a supervisor called me back and apologized for the erroneous information that this woman repeatedly gave me during our 45 minute conversation. If she HAD spoken to a supervisor, she would have realized she was wrong.

If this were a life or death medical emergency, I could understand being upset. At any rate the name-calling was really unnecessary. While it may feel good to vent your spleen that way, it accomplishes nothing. As people say on the RB all the time, if you call and get someone who cannot help you, just thank them, hang up and call back to get someone else.

 

[Pea-n-Me]

I was completely ticked off by the whole series of events.

Trish, sorry this happened to you. I can tell you as a hospital worker, we don't like it either. We are not accustomed to keeping information from people (at least at my hospital), and having to take this approach is uncomfortable for us. Unfortunatly, the new rules have left more questions than answers so the correct response is not always clear or easy.

 

[Tigger_Magic]

Trish, sorry this happened to you. I can tell you as a hospital worker, we don't like it either. We are not accustomed to keeping information from people (at least at my hospital), and having to take this approach is uncomfortable for us. Unfortunatly, the new rules have left more questions than answers so the correct response is not always clear or easy.

That's the biggest problem with HIPAA -- there are so many rules in play now that it's hard to know with any certainty what you are allowed and not allowed to do. Considering how stiff the penalties are for violations, companies regularly encourage employees to err on the side of caution -- maybe too MUCH caution. But there are just too many questions and not enough answers/clarifications. My employer and I are not ready to be the test case and I don't know of anyone or any company that is.

 

[Maleficent13]

HIPAA is very confusing, and very frustrating...but point blank, if your kid is over 18, they speak for themselves. If you want access to his/her info, get a POA or notarized document drawn up signed by him/her that allows you the right to his/her medical info. Be ready to give/fax it to insurances, hospitals, MDs, equipment companies, etc. Once they have that piece of paper they'll tell you anything you want to know. Without it, I won't tell you anything. I am not about to be named defendant in a suit alleging that I gave out priviledged information to a non-authorized person. I won't put myself or my company at risk. And quite honestly, I don't think it's right to be asked to.

I do understand to the family it's frustrating. But please try to understand that my hands are just as tied as yours, and I'm just as frustrated by it as you are. Once again, it appears we are trying to legislate common sense since so few have it. MHO, YMMV.

 

[MELISAZACK]

coming from the insurace claim insdustry - HIPPA is very tricky over 18 means parents have no rights unless they are given verbal or written permission from the person the med rec is on...here at my job that includes payments...
Sorry but rules and rule and the penalty is not worth it.....
Even spouses have no rights.....It is a hard hard issue but thank the goverment for the protection.....

 

[DawnCt1]

Sorry Dawn, but if your son is over 18 you do not have the legal right to his medical OR financial information without his consent. In this situation, I think the insurance company was correct in denying you that information.

Of course, the whole situation is rather ludicrous because I could have called, said I was your son, and gotten the info with no trouble. And if you were calling about a daughter instead of a son, you could have just claimed to be her and would have gotten no argument. So the system is not at all secure.

I never have that issue with the primary dental insurance and this is the first time I have had the issue with this insurance. In fact, I called last week and they hadn't received the claim yet. There is absolutely no medical information I am seeking. I am the policy holder, the check will be cut to me, and all of the EOBs come to me. They put things in writing, with date of service and procedure and send them through the mail but they can't tell me if they have received the claim and if the check is in the mail. There are some areas that are indeed HIPAA exempt. Employee health is one. I can't believe that an inquiry into what funds are due in the mail is covered.