If you’re like most people, the last thing you want in an emergency is your loved ones being denied access to your medical information. Who gets to know what is primarily governed by the Health Insurance Portability and Accountability Act (HIPAA). However, a non-profit agency insists that many doctors, other healthcare providers and insurers have misconceptions about information family members can receive under HIPAA.
What is HIPPA?
HIPAA was birthed in 1996 and is administered by the U.S. Department of Health & Human Services (HHS). The HIPAA privacy rule is enforced by the HHS Office for Civil Rights.
The intent of this legislation was protecting the privacy of health information and spelling out the rules on gaining access to such information when it can be linked to a specific individual.
One of organizations concerned about potential misuse of HIPAA and withholding information that can be released to families is the Center for Democracy and Technology (CDT), a non-profit agency with offices in Washington, DC, and San Francisco. In 2008, CDT began an initiative to address the tangle of privacy issues associated with the utilization of health information technology.
The Washington Post describes several scenarios in which family members had difficulty getting necessary information from healthcare providers or insurers. One is especially similar to my own experience.
My husband and I are covered under my medical insurance policy. After his visit to our vision care provider, I needed to file a claim for partial reimbursement under an additional policy I purchased. This required a copy of the explanation of benefits from the primary insurer plus an itemized bill from the doctor showing the diagnostic codes used and each respective charge.
Since my husband didn’t receive this information at his visit, I called the provider’s office. The receptionist referred me to the biller who processed the practice’s health insurance claims. When I reached her, I politely explained what I needed and said that I was the policy holder and the one who needed to sign the claim form.
The insurance biller firmly refused to give me any information until my husband authorized it. After she spoke with him, she would only agree to mail it to him.
The Post quotes Deven McGraw, director of the CDT’s health privacy project, as stating that it has never been true that HIPAA prohibits doctors, healthcare providers and insurers from discussing a patient’s medical information with family members. Unless the patient has an objection, she explains, such information can be shared with these individuals. Until all providers acknowledge this, what can you do to make sure your family members won’t be shut out when they need information?
Planning documents such as advanced medical directives and living wills specify who can have access to information commonly restricted by providers under HIPAA. They also include your wishes about the level of care used to prolong your life, such as whether you would want to be put on a respirator.
A document that names the individual you want to make medical decisions for you when you can’t is known as a health-care proxy. Sometimes this information is part of an advanced medical directive. Since state law varies, you should contact a local attorney to draft any of these documents.
Provisions also differ among the states as to who can make decisions for their loved ones. The Post indicates that typical provisions name a spouse as highest in the pecking order. When there is no spouse, states specify who, based on relationship, would be eligible to make the decisions about your care.
In order to prevent some of the problems due to what healthcare and insurance providers don’t know about HIPAA, be sure to fill out HIPAA disclosure forms for each doctor who treats you. For planned hospital procedures, provide the staff with a photocopy of any planning document. Finally, wearing a medical alert emblem that specifies chronic illnesses or drug allergies can minimize the information family members need from providers in order to make important decisions.