"Confidential Communication" is part of the HIPAA Privacy Final Rule. The preamble
explains this situation pretty well, and gives some good examples.
Susan Warren
>>> "Ken Hoover" <[EMAIL PROTECTED]> 8/3/01 2:18:53 PM >>>
Yes, that was part of my question. I believe Susan answered it with her
statement:
"You will have to allow for a "Confidential Communication" method -
if an individual reasonably requests that their information be sent to
another address because it could potentially cause them harm - but I don't
see this being the norm."
Is this "Confidential Communication" part of the existing HIPAA regulations?
Or some other type of law?
Ken
-----Original Message-----
From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]]
Sent: Friday, August 03, 2001 2:56 PM
To: Susan Warren; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: Privacy Questions re: Explanation of Benefits and
AdultDependents
Ken's scenario seems to imply 2 questions that might be relevant when the
subscriber and patient are both adults: 1. Who has the presumed/default
entitlement to both the money and the EOB information, and 2. Is there a
way for the payor to redirect that in cases where the standard presumptions
about information access would cause problems for the subscriber or the
patient. I would assume that the subscriber would generally be the default
payee and the default receiver of the EOB information. But I think that
the business model should have a separate element for "Default Payee" so
that you can have a mechanism for redirecting it to avoid harming or
embarrassing someone. For me, the critical question seems to be: Even
though the rule appears to give the payor blanket rights to disclose EOB
information to the subscriber, would an adult patient be able to override
that and insist that his/her own health information NOT be disclosed to a
subscriber in a particular case? (Was this your question, Ken?)
-Chris Feahr
At 11:50 AM 8/3/01 -0500, Susan Warren wrote:
>I'm not sure I entirely understand what you are looking for here, but in
>the case of EOBs and Privacy...
>
>Privacy should not effect your EOB process as a whole. I have cut out two
>sections in the Privacy Rules where HHS has responded in the Final Rule
>that the generation of the EOB containing information other than the
>policy holder is permitted since it is considered a payment
>operation. Therefore, the way you send your EOBs and checks today will
>not necessarily have to change. You will have to allow for a
>"Confidential Communication" method - if an individual reasonably requests
>that their information be sent to another address because it could
>potentially cause them harm - but I don't see this being the norm.
>
>Privacy Final Rules, page 82607, column 3
>Comment: A commenter noted that the definition of ''disclosure'' should
>reflect that health plan correspondence containing protected health
>information, such as Explanation of Benefits (EOBs), is frequently sent to
>the policyholder. Therefore, it was suggested that the words ''provision
>of access to'' be deleted from the definition and that ''disclosure'' be
>clarified to include conveyance of protected health information to a third
>party.
>Response: The definition is, on its face, broad enough to cover the
>transfers of information described and so is not changed. We agree that
>health plans must be able to send EOBs to policyholders. Sending EOB
>correspondence to a policyholder by covered entity is a disclosure for
>purposes of this rule, but it is a disclosure for purposes of payment.
>Therefore, subject to the provisions � 164.522(b) regarding Confidential
>Communications, it is permitted even it discloses to the policyholder
>protected health information about another individual (see below).
>
>Privacy Final Rule, page 82615, column 2
>Comment: Certain commenters explained that third party administrators
>usually communicate with employees through Explanation of Benefit (EOB)
>reports on behalf of their dependents (including those who might not be
>minor children). Thus, the employee might be apprised of the medical
>encounters of his or her dependents but not of medical diagnoses unless
>there is an over-riding reason, such as a child suspected of drug abuse
>due to multiple prescriptions. The commenters urged that the current claim
>processing procedures be allowed to continue.
>Response: We agree. We interpret the definition of payment and, in
>particular the term ''claims management,'' to include such disclosures of
>protected health information.
>
>
> >>> "Ken Hoover" <[EMAIL PROTECTED]> 8/3/01 11:02:51 AM >>>
>Scenario:
>
>Participant (employee) has an adult dependent (spouse, child 18 or over,
>etc).
>
>The dependent receives services from a provider to whom should the payer
>send the explanation of benefits (EOB) to (Participant or Dependent)? What
>if there is a reimbursement due to participant/dependent? Who gets the
>check?
>
>Thanks,
>Ken Hoover
>Acclamation Systems, Inc
>
>
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>
>
>
>
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Christopher J. Feahr, OD Vision Data Standards Council
Executive Director http://visiondatastandard.org
Cell/Pager: 707-529-2268 [EMAIL PROTECTED]
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