HIPAA: What it is, What it was supposed to be, How it affects your claims…

HIPAA: What it is, What it was supposed to be, How it affects your claims…

The Health Insurance Portability and Accountability Act of 1996 was an act of Congress intended to address the security and privacy of health data. Provisions of the act apply to paper, phone, and especially electronic transfers of this sensitive information. HIPAA provides basic protections for your information and gives you certain rights.

Among them are: the rights to see your records, request changes or additions, receive a copy, and receive a list of those who have seen your records. Unfortunately, you don’t have the right to change them even if horrendously wrong, nor can you remove them from the provider’s office.

The fact is, the insurance industry is increasingly computerized, and is moving toward a majority of claims being submitted electronically rather than by mail or even by fax. Your paper claim is probably keyed into, or electronically read, and the original image kept in virtual form while the paper form is shredded. All this improves their productivity, however there is the chance that sensitive records can be hacked into and so that was the rationale for this law.

There are many gaps in your rights, such as your consent is not required when information is needed for your treatment or for the payment of treatment. But many providers are bending over backwards to protect your privacy even if the insurance company requests records, so you will have to ask your provider what their policy is.

If you have a complaint, your first contact is the provider who can often resolve any issue promptly. However you must file a complaint with HHS within 180 days of learning about the incident -- another way they avoid being swamped with complaints. And HIPAA does not give you the right to sue in court for violating your privacy. You have to rely on some other state or federal law to protect your rights to sue.

I personally have seen problems with the application of the HIPAA rules to the point of ridiculousness. In the case of an adult child who is away at college, the parent may not discuss an insurance or treatment issue with the provider without an express letter from the student giving permission for Mom and Dad to do so.

Also I had a case where the parent was not on a policy for the children, and this fact meant that we could not update their address on the policy (even though the children were minors). Make a point of asking providers how they handle these issues sooner rather than later.