If a patient's records can be seized by their insurance company even if their treating physician does NOT accept insurance and does NOT deal with the patient's insurance company.
I'm looking for an answer based on specific knowledge, please.
Thanks in advance, Melanie
[ 08-08-2009, 12:17 PM: Message edited by: Melanie Reber ]
Posted by bettyg (Member # 6147) on :
mel,
i'd copy this to SUPPORT too as we have many lawyers who visit there only ... fyi Posted by Aniek (Member # 5374) on :
Generally, you sign something when you start with a doctor that gives permission for the physician to share information with your insurance company in order to have your claims paid.
So, hypothetically, if you didn't sign such a form, I don't believe the doctor can legally share the information with the insurance company.
Unless you gave permission to the insurance company to access all of your medical records, which is possible could have been in small print somewhere in the material you received when you applied or in the plan description.
Posted by bettyg (Member # 6147) on :
aniek, you are 1 of those i was thinking about when i replied above; thx for good advise hugs/kisses my friend
Posted by Melanie Reber (Member # 3707) on :
Thank you both SO much! I will post some more information sent to me later when I'm feeling a bit better. M
Posted by Melanie Reber (Member # 3707) on :
Aniek,
Thank you for that reply. Yes, most of us sign a waiver when we first begin with a particular practice that outlines the 'Privacy Practices' of the office and lists the situations re: why and when our medical information can be used and disclosed.
After reviewing my latest waiver, however... I did not find anything that specifically addresses insurance companies. Although, it does say that not all uses are outlined in the waiver, and that any other purpose would require written permission from the patient. Perhaps that is the 'get around' for both the practice and the insurance company?
And yes, when we sign up with an insurance company we are normally waiving our rights to disclosure of certain records... if necessary. I suppose I should clarify that I am referring to a seizure of the entire patient chart and not just certain records contained within that chart.
Knowing that some patients are having issues with insurance companies that utilize ALL medical records that are supposed to be private though... I became curious as to how these records are legally accessed if the physician does not readily disclose all of our information.
A very enlightening answer on Medical Records Privacy and things NOT covered under HIPAA laws was sent to me yesterday that I would like to share below.
.......
"Click around on this website, such as their FAQ, etc., in addition to reading this webpage and the links provided in it - (especially the links under item #3, examples shown below)."
3. The Medical Information Bureau (MIB) is a central database of medical information shared by insurance companies....
*** The MIB does not have a file on everyone. But if you have an MIB file, you will want to be sure it is correct. You can obtain a copy for free once a year by calling (866) 692-6901 (TTY for the hearing impaired (866) 346-3642) or by visiting the company's web site at: http://www.mib.com/html/request_your_record.html
In general the MIB can be contacted at Medical Information Bureau, P.O. Box 105, Essex Station, Boston, MA 02112, or by sending an email to: [email protected]
3a. IntelliScript and MedPoint are databases that report prescription drug purchase histories to insurance companies. Like the MIB reports, IntelliScript and MedPoint reports are used primarily when consumers are seeking private health, life or disability insurance. Prescription drug databases can go back as far as five years, detailing drugs used as well as dosage and refills...
*** Individuals who have applied for individual health, life or disability insurance may also request a copy of any prescription report directly from MedPoint or IntelliScript. Reports are available once a year whether or not there has been an adverse decision by an insurance company.
You can request a copy of your MedPoint report by calling (888) 206-0335 or writing to: MedPoint Compliance, Ingenix, Inc., 2525 Lake Park Blvd, West Valley City Utah 84120. Additional contact information can be found at: www.ingenix.com/ContactUs/
IntelliScript reports are available by calling the toll-free request line at (877) 211-4816. Consumers will have to provide their full name, date of birth, last four digits of their Social Security number and current zip code. Milliman will provide a copy of any information the company has on an individual as well as the names of insurance companies that have requested a prescription history. The company's Web site includes information about the product as well as additional contact information: www.rxhistories.com/how_it_works.html
...
For those of us who have been denied insurance coverage and/or reimbursement on claims... this information is incredibly provocative and extremely useful.
[ 08-08-2009, 11:37 AM: Message edited by: Melanie Reber ]
Posted by lou (Member # 81) on :
Well, the question I would have is whether the patient whose chart was "seized" was attempting to have the insurance co pay for part of the bill of an out-of-network doctor. They would then presumably have been given permission by you thru the claim and the insurance contract to access relevant records.
Whether that would allow them to take all records, not just the ones related to the claim, is the question, and I bet the wording in the contract covers them. Very doubtful that ins cos would miss any tricks. Most patients don't read the fine print.
The patient could instruct the doctor's office to withhold all records from ins cos, but that would surely cause them to reject the claim. Or the patient could limit their access to only related records, but the doctor's office would have to be running interference on this and it might be a hassle. They might also not tell the patient about requests from insurance cos in a timely way so the patient could deny access.
Posted by bettyg (Member # 6147) on :
good info melanie; thx
Posted by Amanda (Member # 14107) on :
You could ask Lorraine, CEO at CALDA. She is a lawyer by training, isn't she? She wrote up example letters to get insurance denials overturned....
Posted by Melanie Reber (Member # 3707) on :
Hey Miss BG, you are most welcome. I think there are a few important things to be gleaned here, at least I learned a few things.
Miss Amanda, to clarify, my records have not been seized... I have no insurance and this is a hypothetical. Although, I am aware of this happening with other patients.
and Lou, I am in complete agreement there. Thank you.
After years of dealing with this, I have become a rather meticulous record keeper. So, to make certain that I was aware of what was actually in MY chart, I asked to have a look this week.
I did find a rather surprising letter that I was not aware of... from the Department of Health requesting proof of a LD diagnosis.
Because I have not been newly diagnosed, I wondered why this request was made of my current treating physician. I am assuming that somehow the DOH got a hold of my records and saw a diagnosis code of LD, among others... as I do not think my doc is/was required to submit a form to the DOH unless it is a new diagnosis with new test results to prove it?
Yes, my receipts have diagnoses codes, including LD, however, because I have no insurance to submit to for reimbursement, I am the only one who sees these receipts... or so I thought.
Posted by TerryK (Member # 8552) on :
This is good info. I plan to contact these data repositories and find out what they have on me.
Melanie, have you asked your doctor why this happened? I would certainly want to know.
Notice requirements Q: Do health providers and other medical entities have to give me specific notice when they turn over my medical files to the government?
A: No. Neither HIPAA nor the Patriot Act require that notice be given to affected individuals, either before their files are turned over (giving them a chance to challenge the privacy infringement) or after the fact. In fact, the Patriot Act actually bans health providers from telling "any other person (other than those persons necessary to produce the tangible things under this section) that the Federal Bureau of Investigation has sought or obtained tangible things."[ix] ------------------------------------------------
This past week I could not get a lab to tell me where they sent my blood for a specific lab test. It was like pulling teeth to find out if they had ever received the results from blood given to them 2 months ago. The HIPAA laws were cited as the reason.
It's outrageous that insurance companies can share information about us such as our drug history. I wonder how they pull that off legally?
Everytime I turn around my insurance company wants more information from my doctor before they will approve a medication. I wonder how much their desire for more detailed medical information plays into their demand for all this additional information?
Edited to add: I should clarify this: what I am trying to say (and not doing a very good job of it) is that I think insurance companies might be making us jump through hoops sometimes just so they can get more information about us. I wonder if they can sell our information? Ultimately I'm sure it's the almighty dollar that rules their motives.
Terry
Posted by Melanie Reber (Member # 3707) on :
Hey there Miss T,
No, I have not had an opportunity to speak directly with my doc about this letter, but most certainly will at my next appointment. I also failed to obtain a copy and am hoping to do that as well.
I'd really like to know how the office responded to this request from the DOH and why I wasn't informed.
Perhaps I am asking for too much here? However, it just doesn't seem right that information about ME being passed from one entity to another, is completely bypassing my attention.
Thank you for that added link.
I'm so sorry about the insurance hassles... it is such a mess, isn't it? As if we don't have enough to contend with...
Posted by TerryK (Member # 8552) on :
Thanks Mel, You wrote: it just doesn't seem right that information about ME being passed from one entity to another, is completely bypassing my attention.
I agree!!! According to the link I gave, the government can get medical information about us without our consent or knowledge and our doctors may even be prohibited from telling us that they've given our information to the government.
I think the U.S. public has been duped with HIPAA. We are told that HIPAA is there for OUR protection. I think that is a ruse.
I am constantly told that I can't have access to my own information because of HIPAA and now I find out that the insurance company can freely share my private information amoung themselves and the government can get any medical information they want without me ever knowing about it.
Terry
Posted by Melanie Reber (Member # 3707) on :
Yes... there is something very wrong with this picture...
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