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Valued Social Butterfly
Posts: 5,563
Registered: ‎07-20-2010

Re: A QUESTIONS ABOUT HIPPA

Message 11 of 17 (143 Views)

GailL1 wrote:

rker321 wrote:

Thank you for the link it was very informative, I wonder if there is a proviso that only the information by the Dr's Hospitals etc when they put a claim and disclose the diagnosis of whatever they are billing from Do they also provide my insurance agency my complete medical history and why? Do I have the right to limit the information that my insurance should have? an still be able to have my claims paid?


No to the last (2) questions but I don't think your insurance agent gets access to your health records but most do require a health history on any application for insurance - this then goes to the insurer for further review and assessment.

Health  insurance agents really don't do much more that a I am aware of except to try to get you coverage if possible.  They are not like home or auto insurance agents who sometimes have a more hands on roll in claims.

 

Your Medicare Advantage plan has access to all your medical data and history.

In fact, they get paid more by Medicare if you have a high risk assessment.

This is one of the ways that Medicare discourages that adverse selection - by paying your advantage plan more to take care of those with lots of health problems.

 

So in fact, your MA plan knows a lot about your health and IF they consider you a higher health risk, they document this to Medicare to increase their payment for you.

 

Medicare even has the authority to question this health assessment for any beneficiary and could do an audit on the medical records to determine your health risk.  Now none of this last part is really by names or specific identifiers but an identifier just to link your records and data for the audit.  Course, I guess they could find out names from that point if they really wanted/needed them.

 

Actually, I don't think that personal medical data and insurance is any different than other types of insurance like life, home, auto.  

 

You have a Lexus-Nexus report that home and auto insurers look at to determine their risk in insuring you.

Life insurers usually make you take a modified physical and answer detailed questions on your medical history and lifestyle with the qualifier in the policy stating that this information becomes part of the contract and if you have lied about anything, the contact or policy is void.

 

If somebody or some entity has a stake in you or your possessions, then that does give them the right to make sure their interest is properly and correctly covered.

 

Part of the responsibility of health insurers - both public and private - is to make sure that the treatment fits the diagnosis and that the treatment you are getting is medically necessary.  The treatment should be standard best practices and not experimental.

 

 


Your para. on the Advantage providers is misleading. Carriers get paid more for everyone they have over what it cost medicare to supply the same medical treatment. It started out I think at 15% and has been reduced some, but not phased out as called for in the ACA. If you notice all carriers have different advantage plans they offer at different prices. They each have an identifier for filing purposes. The Carriers do this so that if they find the risk pool is a looser they just do not offer that plan the next year (they have cancelled all in it.). The people in the pool have to buy another plan at higher costs usually or go and buy from a different carrier. In my state a few years ago Blue Cross cancelled all its plans when the state said no to their rate increase. That lasted for a year and they were back. The Carriers make money on these plans since they usually add little cost to them with the extras they throw in. Did you see the article from Kisaer trashing the advantage programs. What the writer said was true but really does not fit into the big picture. No one should rule out purchasing advantage plan because of it. I think the advantage plans do have a place in health coverage, but they should not get more from medicare that it costs medicare to provide the same medical benefits.

Valued Social Butterfly
Posts: 8,625
Registered: ‎08-18-2008

Re: A QUESTIONS ABOUT HIPPA

[ Edited ]
Message 12 of 17 (132 Views)

rker321 wrote:

Thank you for the link it was very informative, I wonder if there is a proviso that only the information by the Dr's Hospitals etc when they put a claim and disclose the diagnosis of whatever they are billing from Do they also provide my insurance agency my complete medical history and why? Do I have the right to limit the information that my insurance should have? an still be able to have my claims paid?


No to the last (2) questions but I don't think your insurance agent gets access to your health records but most do require a health history on any application for insurance - this then goes to the insurer for further review and assessment.

Health  insurance agents really don't do much more that a I am aware of except to try to get you coverage if possible.  They are not like home or auto insurance agents who sometimes have a more hands on roll in claims.

 

Your Medicare Advantage plan has access to all your medical data and history.

In fact, they get paid more by Medicare if you have a high risk assessment.

This is one of the ways that Medicare discourages that adverse selection - by paying your advantage plan more to take care of those with lots of health problems.

 

So in fact, your MA plan knows a lot about your health and IF they consider you a higher health risk, they document this to Medicare to increase their payment for you.

 

Medicare even has the authority to question this health assessment for any beneficiary and could do an audit on the medical records to determine your health risk.  Now none of this last part is really by names or specific identifiers but an identifier just to link your records and data for the audit.  Course, I guess they could find out names from that point if they really wanted/needed them.

 

Actually, I don't think that personal medical data and insurance is any different than other types of insurance like life, home, auto.  

 

You have a Lexus-Nexus report that home and auto insurers look at to determine their risk in insuring you.

Life insurers usually make you take a modified physical and answer detailed questions on your medical history and lifestyle with the qualifier in the policy stating that this information becomes part of the contract and if you have lied about anything, the contact or policy is void.

 

If somebody or some entity has a stake in you or your possessions, then that does give them the right to make sure their interest is properly and correctly covered.

 

Part of the responsibility of health insurers - both public and private - is to make sure that the treatment fits the diagnosis and that the treatment you are getting is medically necessary.  The treatment should be standard best practices and not experimental.

 

 

Valued Social Butterfly
Posts: 22,314
Registered: ‎03-04-2009

Re: A QUESTIONS ABOUT HIPPA

Message 13 of 17 (116 Views)

Thank you for the link it was very informative, I wonder if there is a proviso that only the information by the Dr's Hospitals etc when they put a claim and disclose the diagnosis of whatever they are billing from Do they also provide my insurance agency my complete medical history and why? Do I have the right to limit the information that my insurance should have? an still be able to have my claims paid?

Highlighted
Valued Social Butterfly
Posts: 8,625
Registered: ‎08-18-2008

Re: A QUESTIONS ABOUT HIPPA

Message 14 of 17 (169 Views)

rker321 wrote:

When I go to the doctor they always give me a HIPPA  page that says more or less that my privacy will be protected.

My question is from whom.?  My own insurance companies?  or what other entities are they protected from
Supposed I don't want any information be given to my insurance will that be then something that they can say, If that if so, I won't pay your claim"

So from whom I am protecting my privacy?


Other entities could be a solicitor - somebody who might want to sell you something.

Other entities could be a member of your family who you have not assigned to get your medical info.  Perhaps a caregiver - authorization has to be specific as to whom your medical info is disclosed

An entity (private) that might keep a database of people with a health condition similar to yours for any number of reasons - marketing, health aids, etc..

The law gives certain entities access to your medical records as long as you authorize it - like to another doctor which you may see.

 

This is a good reference and there are short videos and a FAQ area.

HHS - All About HIPAA - Health Insurance Portability and Accountability Act

Treasured Social Butterfly
Posts: 21,220
Registered: ‎06-09-2010

Re: A QUESTIONS ABOUT HIPPA

[ Edited ]
Message 15 of 17 (167 Views)

Anyone who may request them...

 

There's usually a seperate line/page for insurance assignment and release of info to your insurance company.

 

And yes, your claim could be suspended until they receive the information necessary to process the claim which may include your medical records.


"FAKE 45 #illegitimate" read a sign at the Woman's March in Washington DC, January 21, 2017.
Treasured Social Butterfly
Posts: 7,560
Registered: ‎11-18-2009

Re: A QUESTIONS ABOUT HIPPA

Message 16 of 17 (166 Views)
Never thought of that. I alwasy approve mine to be shared openly due to my condition..doctor consults etc.
So it begins.
Valued Social Butterfly
Posts: 22,314
Registered: ‎03-04-2009

A QUESTIONS ABOUT HIPPA

Message 17 of 17 (155 Views)

When I go to the doctor they always give me a HIPPA  page that says more or less that my privacy will be protected.

My question is from whom.?  My own insurance companies?  or what other entities are they protected from
Supposed I don't want any information be given to my insurance will that be then something that they can say, If that if so, I won't pay your claim"

So from whom I am protecting my privacy?