Sunday, January 13, 2013

HIPAA - That bill is private, but pay it anyway!

Over the past several years, I have watched as HIPAA - the Health Insurance Portability and Accountability Act of 1996, has been rolled out.  It is good to see more emphasis on keeping your health information private.  Many months ago, I first encountered the down side of privacy - that is, lack of information.  I had received a bill and after contacting the health care provider was essentially informed that 1.  No, they could not provide me information about the service (due to HIPAA) and 2. Yes, I was responsible for payment.  I found this provider's conclusion very interesting and their logic flowed something like this:
1.  The family member who had been treated was of legal age, thus they could not disclose medical information without their consent AND
2.  The "guarantor" is the primary holder of the insurance who is ultimately responsible for ensuring payment.
In contrast, my logic flows something like this:

1.  The family member who had been treated was of legal age, thus they could not disclose medical information without their consent AND
2.  The family member, being of legal age, is the responsible individual who consented to treatment and as such is the one who entered into a contractual relationship with the health care provider (e.g. service for payment so chase them for the bill and leave me alone).  (Personally, I think it would be a good thing for these adult family members to be a bit more engaged and aware of the billing end of health care.  It is important information for all responsible adults).
I have long learned that sometimes it does not pay to waste your breath in argument over the fine points.  In this situation the bottom line is that I would ultimately pay the bill and as the bill payer, I would certainly hope to have the cooperation of my family member to obtain whatever information I needed.  Regardless, I confess that it does irk me to some degree that payment is being demanded from me and yet I cannot expect disclosure of what I am paying for from the person demanding payment.

Similarly, my health plan provides on line information regarding claims and I have observed how HIPAA has been interpreted and how the resulting claims information has been diluted for covered family members 18 and older.  For example, prior to the team of health care providers identifying my wife as having heart issues, she had been prescribed a medication  for severe migraines that is also commonly used as a psychotropic.  Apparently, "psychotropic" triggers "super duper" privacy as the name of the medication was conspicuously absent from the explanation of benefits that I was able to view on line.  Well, no need to keep it a secret, after 21 years of marriage, I know she is crazy... and I might have to sneak a tablet or two for myself as well.

The Affordable Care Act has recently extended the eligibility age of family members to 26.  It will be interesting to watch how the traditional billing mentality that the primary insured is the guarantor of payment will be reconciled with health care choices that are being made by "consenting adult" dependents who are treated as adults when it comes to health care privacy, but as children when it comes to the payment of the bill.  For many of the "nickel and dime" routine health care this may not be such a big issue, but what happens when your 25 year old who has been out of the house for 4 years incurs a big hospital bill and the hospital is an aggressive collector that insists on pursuing the primary insured on the policy?  I venture to guess that this dilemma will be all the more entertaining in estranged families where relationships are already strained.

This is one of those posts where I had sketched out some thoughts, then placed it on the shelf thinking it was still half baked... and then it happened last week.  I was watching "Untold Stories of the E.R." which is a dramatization of actual events from the Emergency Room.  The patient was a young female who was brought to the ER by her parents with severe abdominal pain.  Patient and parents strongly denied any possibility of pregnancy, but despite the denials, based on the symptomology, the ER doctor continued to suspect pregnancy.  Upon verification of an Ectopic pregnancy, the doctor related that it was "illegal" for him to tell the parents and he didn't.  The "drama" part of the show was centered on the doctor's creativity in using a centrifuge to separate the blood to verify the (denied) pregnancy after the patient was unable to provide a urine sample and the show did not get into the financial issues.  In this case, there was clearly an ER visit, the Ectopic pregnancy required surgery and following surgery I would venture to guess a short admission so it is a safe bet that a substantial hospital bill was incurred.  As I've stated, the show focused on the medical drama, not the financial drama so for the sake of illustration some speculation is necessary.  In this case the young patient appeared to be somewhere around 18-21 and had clearly not "left the nest".  I would hazard a guess that she was on her parent's health plan and I would be curious to learn what information was placed on the bill and the Explanation of Benefits (from the insurer).  I certainly agree that the patient is entitled to her privacy; however, with the respect and privileges of being an adult also come responsibilities.

If the patient is an adult; treat them like an adult... keep their privacy AND send them the bill... until then the absurdity of bureaucracy will continue... so here's your bill, but we can't tell you what you're paying for.

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