RE: Some Questions that I've asked before....
Hi Beth... thanks for responding. If I understand your comments/suggestions, we can't grant a 12 year old (below age of majority/emancipation) Private Communications, unless he/she has a court order allowing he/she control of their own health care? This is regardless of the claim of harm that may result? All opinions expressed are my own and should not be construed to be Medical Mutual or Antares Management Solutions official policy. Jim Moores - HIPAA Team Leader - PrivacyAntares Management Solutions23700 Commerce Park RoadBeachwood, Ohio 44122-5832 [EMAIL PROTECTED]Phone: (216)292-1605Fax: (216)292-1619 >>> <[EMAIL PROTECTED]> 01/28/03 06:40PM >>> I will only take 3) 164.502 (g)(1) requires that you treat a Personal Representative as the individual i.e. must give access (g)(3) requires that you treat a parent or guardian as a Personal Representative The only exceptions provided are described in (g)(3) which seem to be very specific and will deal with specific instances of provider confidentiality or parental estrangement that you suggest - you should look at this section for yourself. and (g)(5) if abuse, neglect, endangerment...if professional judgment If the case does not fit the above specific situation, looks like you cannot refuse info to the parent - parent being defined by the state's legal age for emancipation. David Ermer also presented a state by state blow of state guardianship laws related to this. That was released on the P&P list serve last week. -Original Message-From: Deborah Campbell [mailto:[EMAIL PROTECTED]]Sent: Tuesday, January 28, 2003 1:36 PMTo: WEDI SNIP Privacy Workgroup ListSubject: RE: Some Questions that I've asked before Here goes my opinion. 1) We haven't decided if we will release any info to the subscriber on one of their members. So couldn't you use this as an excuse? Say, "I'm sorry, according to the new HIPAA regulations, we are unable to release any further information without an authorization from the member." 2) We don't send EOB's so can't help you there. 3) Didn't the 8/14/03 revisions say when it comes to minors, we should follow state regs? Does the state allow you to limit info to parents of underage minors? 4) Not sure what the question is. Yes, if we turn down an amendment request, and the member requests that we log the amendment request in the records, we must. Sorry I couldn't be more help. Deborah Campbell Compliance Coordinator Dominion Dental Services, Inc. 115 South Union Street, Suite 300 Alexandria, Virginia 22314 Phn: (703) 518-5000 ext. 3035 Fax: (703) 518-8849 Toll Free: 888-518-5338 Email: [EMAIL PROTECTED] *** The information in this email is confidential and may be legally privileged. It is intended solely for the addressee. Access to this email by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on it is prohibited and may be unlawful. * -Original Message-From: Jim Moores [mailto:[EMAIL PROTECTED]]Sent: Tuesday, January 28, 2003 10:06 AMTo: WEDI SNIP Privacy Workgroup ListSubject: Some Questions that I've asked before Hi All, I've asked these questions before, but didn't get much response (or any at all on some). Since we're all getting close to THE DATE, I thought re-asking might get more/better response, so I'm re-posting a digest of the questions. Any discussions of what you are doing and / or suggestions are welcome. _ Private Communications These questions are about Private Communications (PC) & Customer Service: 1) How do you respond to a Customer Service Inquiry from the contract holder (subscriber) when someone on that contract has invoked PC? Do you just say, "I can't give any further information" or "I've released all the information to which you are entitled" or some other sentence/phrase with similar meaning? I realize you can't just say, "Someone on your contract has requested Private Communications". Possible scenario: Jane, the wife of Joe Contractholder requests PC, primarily because she's going to a psychologist. Because Jane has requested PC, the insurance company (or provider) routes ALL her claim EOBs (or bills) to an alternate address. Joe calls customer service to ask where the Explanation of Benefits
RE: Some Questions that I've asked before....
I will only take 3) 164.502 (g)(1) requires that you treat a Personal Representative as the individual i.e. must give access (g)(3) requires that you treat a parent or guardian as a Personal Representative The only exceptions provided are described in (g)(3) which seem to be very specific and will deal with specific instances of provider confidentiality or parental estrangement that you suggest - you should look at this section for yourself. and (g)(5) if abuse, neglect, endangerment...if professional judgment If the case does not fit the above specific situation, looks like you cannot refuse info to the parent - parent being defined by the state's legal age for emancipation. David Ermer also presented a state by state blow of state guardianship laws related to this. That was released on the P&P list serve last week. -Original Message-From: Deborah Campbell [mailto:[EMAIL PROTECTED]]Sent: Tuesday, January 28, 2003 1:36 PMTo: WEDI SNIP Privacy Workgroup ListSubject: RE: Some Questions that I've asked before Here goes my opinion. 1) We haven't decided if we will release any info to the subscriber on one of their members. So couldn't you use this as an excuse? Say, "I'm sorry, according to the new HIPAA regulations, we are unable to release any further information without an authorization from the member." 2) We don't send EOB's so can't help you there. 3) Didn't the 8/14/03 revisions say when it comes to minors, we should follow state regs? Does the state allow you to limit info to parents of underage minors? 4) Not sure what the question is. Yes, if we turn down an amendment request, and the member requests that we log the amendment request in the records, we must. Sorry I couldn't be more help. Deborah Campbell Compliance Coordinator Dominion Dental Services, Inc. 115 South Union Street, Suite 300 Alexandria, Virginia 22314 Phn: (703) 518-5000 ext. 3035 Fax: (703) 518-8849 Toll Free: 888-518-5338 Email: [EMAIL PROTECTED] *** The information in this email is confidential and may be legally privileged. It is intended solely for the addressee. Access to this email by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on it is prohibited and may be unlawful. * -Original Message-From: Jim Moores [mailto:[EMAIL PROTECTED]]Sent: Tuesday, January 28, 2003 10:06 AMTo: WEDI SNIP Privacy Workgroup ListSubject: Some Questions that I've asked before Hi All, I've asked these questions before, but didn't get much response (or any at all on some). Since we're all getting close to THE DATE, I thought re-asking might get more/better response, so I'm re-posting a digest of the questions. Any discussions of what you are doing and / or suggestions are welcome. _ Private Communications These questions are about Private Communications (PC) & Customer Service: 1) How do you respond to a Customer Service Inquiry from the contract holder (subscriber) when someone on that contract has invoked PC? Do you just say, "I can't give any further information" or "I've released all the information to which you are entitled" or some other sentence/phrase with similar meaning? I realize you can't just say, "Someone on your contract has requested Private Communications". Possible scenario: Jane, the wife of Joe Contractholder requests PC, primarily because she's going to a psychologist. Because Jane has requested PC, the insurance company (or provider) routes ALL her claim EOBs (or bills) to an alternate address. Joe calls customer service to ask where the Explanation of Benefits (EOB) is for his wife's recent visit to the Emergency Room for a twisted ankle. How should the customer service rep answer? 2) How do you send out the EOB when you have a non-custodial and custodial parent getting EOBs and one of the children has invoked PC? We have a number of these situations where we have received a Domestic Relations Court Order to send the underage dependent EOBs to both the custodial and non-custodial parents. As long as they haven't reached 18, we comply with the order (or if a dependent is in college, until they graduate). Possible scenario: Joe Doe (Contractholder) and Jane Doe (Joe's former wife and mother
RE: Some Questions that I've asked before....
Jim, Here is a site that contains a document regarding designated record set that might useful to you. http://www.nchica.org/HIPAAResources/Samples/DesRecSets.pdf Phyllis Line HIPAA Privacy Officer HEREIU Welfare Pension Funds 630-236-5114 [EMAIL PROTECTED] -Original Message-From: Deborah Campbell [mailto:[EMAIL PROTECTED]]Sent: Tuesday, January 28, 2003 12:36 PMTo: WEDI SNIP Privacy Workgroup ListSubject: RE: Some Questions that I've asked before Here goes my opinion. 1) We haven't decided if we will release any info to the subscriber on one of their members. So couldn't you use this as an excuse? Say, "I'm sorry, according to the new HIPAA regulations, we are unable to release any further information without an authorization from the member." 2) We don't send EOB's so can't help you there. 3) Didn't the 8/14/03 revisions say when it comes to minors, we should follow state regs? Does the state allow you to limit info to parents of underage minors? 4) Not sure what the question is. Yes, if we turn down an amendment request, and the member requests that we log the amendment request in the records, we must. Sorry I couldn't be more help. Deborah Campbell Compliance Coordinator Dominion Dental Services, Inc. 115 South Union Street, Suite 300 Alexandria, Virginia 22314 Phn: (703) 518-5000 ext. 3035 Fax: (703) 518-8849 Toll Free: 888-518-5338 Email: [EMAIL PROTECTED] *** The information in this email is confidential and may be legally privileged. It is intended solely for the addressee. Access to this email by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on it is prohibited and may be unlawful. * -Original Message-From: Jim Moores [mailto:[EMAIL PROTECTED]]Sent: Tuesday, January 28, 2003 10:06 AMTo: WEDI SNIP Privacy Workgroup ListSubject: Some Questions that I've asked before Hi All, I've asked these questions before, but didn't get much response (or any at all on some). Since we're all getting close to THE DATE, I thought re-asking might get more/better response, so I'm re-posting a digest of the questions. Any discussions of what you are doing and / or suggestions are welcome. _ Private Communications These questions are about Private Communications (PC) & Customer Service: 1) How do you respond to a Customer Service Inquiry from the contract holder (subscriber) when someone on that contract has invoked PC? Do you just say, "I can't give any further information" or "I've released all the information to which you are entitled" or some other sentence/phrase with similar meaning? I realize you can't just say, "Someone on your contract has requested Private Communications". Possible scenario: Jane, the wife of Joe Contractholder requests PC, primarily because she's going to a psychologist. Because Jane has requested PC, the insurance company (or provider) routes ALL her claim EOBs (or bills) to an alternate address. Joe calls customer service to ask where the Explanation of Benefits (EOB) is for his wife's recent visit to the Emergency Room for a twisted ankle. How should the customer service rep answer? 2) How do you send out the EOB when you have a non-custodial and custodial parent getting EOBs and one of the children has invoked PC? We have a number of these situations where we have received a Domestic Relations Court Order to send the underage dependent EOBs to both the custodial and non-custodial parents. As long as they haven't reached 18, we comply with the order (or if a dependent is in college, until they graduate). Possible scenario: Joe Doe (Contractholder) and Jane Doe (Joe's former wife and mother of Donna Doe) have both been receiving Donna's EOBs pursuant to a court order. Donna's in college and goes to her OB/Gyn and asks for birth control pills. Donna doesn't want her father to know (he has a temper), so she invokes PC with both the Provider and the insurance company. All of a sudden, neither Joe or Jane are getting copies of Donna's EOB's. Jane knows that Donna went to the OB/Gyn but doesn't get a copy of the EOB. She calls Joe and asks if he has gotten the EOB yet... of course he says no. So she call
RE: Some Questions that I've asked before....
Hi Deborah, Thank you for responding... See my comments in Bold>>> "Deborah Campbell" <[EMAIL PROTECTED]> 01/28/03 01:36PM >>> Here goes my opinion. 1) We haven't decided if we will release any info to the subscriber on one of their members. So couldn't you use this as an excuse? Say, "I'm sorry, according to the new HIPAA regulations, we are unable to release any further information without an authorization from the member." The policy so far is to respond to queries (especially about deductibles which apply to the all members) unless there is a Private Communications Request. I'm like you, just refuse to respond unless the caller is the patient Maybe I'll try to bring the idea up (again) as the policy/standard. 2) We don't send EOB's so can't help you there. 3) Didn't the 8/14/03 revisions say when it comes to minors, we should follow state regs? Does the state allow you to limit info to parents of underage minors? Unfortunately, the State Laws/Regs are silent on most of the implications of the questions I posed. For example, what are our obligations to an underage member, who wants to claim Private Communications Do we advise the member to go see the county social services? Do we refuse? No easy answers here. We know that we can't grant Private Communications for a 12 year old (unless there is a guardian appointed by a court) My questions more revolve around what should we do (within the constraints of state law and HIPAA regs). 4) Not sure what the question is. Yes, if we turn down an amendment request, and the member requests that we log the amendment request in the records, we must. Sorry, I should have been more clear. I accept that we have to accept the amendment flag and statement. I'd like to know how other CE's are handling the identification of the situation where an amendment was requested and how they are associating / effecting the transmission of the flag and statement with the claim On EOBs, On 835 Transactions, On data transmissions to a Cost Plus Group, On data transmissions to the state dept of insurance for our biannual audit, etc Sorry I couldn't be more help. Deborah Campbell Compliance Coordinator Dominion Dental Services, Inc. 115 South Union Street, Suite 300 Alexandria, Virginia 22314 Phn: (703) 518-5000 ext. 3035 Fax: (703) 518-8849 Toll Free: 888-518-5338 Email: [EMAIL PROTECTED] *** The information in this email is confidential and may be legally privileged. It is intended solely for the addressee. Access to this email by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on it is prohibited and may be unlawful. * -Original Message-From: Jim Moores [mailto:[EMAIL PROTECTED]]Sent: Tuesday, January 28, 2003 10:06 AMTo: WEDI SNIP Privacy Workgroup ListSubject: Some Questions that I've asked before Hi All, I've asked these questions before, but didn't get much response (or any at all on some). Since we're all getting close to THE DATE, I thought re-asking might get more/better response, so I'm re-posting a digest of the questions. Any discussions of what you are doing and / or suggestions are welcome. _ Private Communications These questions are about Private Communications (PC) & Customer Service: 1) How do you respond to a Customer Service Inquiry from the contract holder (subscriber) when someone on that contract has invoked PC? Do you just say, "I can't give any further information" or "I've released all the information to which you are entitled" or some other sentence/phrase with similar meaning? I realize you can't just say, "Someone on your contract has requested Private Communications". Possible scenario: Jane, the wife of Joe Contractholder requests PC, primarily because she's going to a psychologist. Because Jane has requested PC, the insurance company (or provider) routes ALL her claim EOBs (or bills) to an alternate address. Joe calls customer service to ask where the Explanation of Benefits (EOB) is for his wife's recent visit to the Emergency Room for a twisted ankle. How should the customer service rep answer? 2) How do you send out the EOB when you have a non-custodial and custodial parent getting EOBs and one of the children has invoked PC? We have a number of these situations where we have received a Domestic Relations Court Order to send the underage dependent EOBs to both the custodial and non-custodial parents. As long as they haven't reached 18, we comply with the order (or if a dependent is in college, until they graduate). Possible
RE: Some Questions that I've asked before....
Here goes my opinion. 1) We haven't decided if we will release any info to the subscriber on one of their members. So couldn't you use this as an excuse? Say, "I'm sorry, according to the new HIPAA regulations, we are unable to release any further information without an authorization from the member." 2) We don't send EOB's so can't help you there. 3) Didn't the 8/14/03 revisions say when it comes to minors, we should follow state regs? Does the state allow you to limit info to parents of underage minors? 4) Not sure what the question is. Yes, if we turn down an amendment request, and the member requests that we log the amendment request in the records, we must. Sorry I couldn't be more help. Deborah Campbell Compliance Coordinator Dominion Dental Services, Inc. 115 South Union Street, Suite 300 Alexandria, Virginia 22314 Phn: (703) 518-5000 ext. 3035 Fax: (703) 518-8849 Toll Free: 888-518-5338 Email: [EMAIL PROTECTED] *** The information in this email is confidential and may be legally privileged. It is intended solely for the addressee. Access to this email by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on it is prohibited and may be unlawful. * -Original Message-From: Jim Moores [mailto:[EMAIL PROTECTED]]Sent: Tuesday, January 28, 2003 10:06 AMTo: WEDI SNIP Privacy Workgroup ListSubject: Some Questions that I've asked before Hi All, I've asked these questions before, but didn't get much response (or any at all on some). Since we're all getting close to THE DATE, I thought re-asking might get more/better response, so I'm re-posting a digest of the questions. Any discussions of what you are doing and / or suggestions are welcome. _ Private Communications These questions are about Private Communications (PC) & Customer Service: 1) How do you respond to a Customer Service Inquiry from the contract holder (subscriber) when someone on that contract has invoked PC? Do you just say, "I can't give any further information" or "I've released all the information to which you are entitled" or some other sentence/phrase with similar meaning? I realize you can't just say, "Someone on your contract has requested Private Communications". Possible scenario: Jane, the wife of Joe Contractholder requests PC, primarily because she's going to a psychologist. Because Jane has requested PC, the insurance company (or provider) routes ALL her claim EOBs (or bills) to an alternate address. Joe calls customer service to ask where the Explanation of Benefits (EOB) is for his wife's recent visit to the Emergency Room for a twisted ankle. How should the customer service rep answer? 2) How do you send out the EOB when you have a non-custodial and custodial parent getting EOBs and one of the children has invoked PC? We have a number of these situations where we have received a Domestic Relations Court Order to send the underage dependent EOBs to both the custodial and non-custodial parents. As long as they haven't reached 18, we comply with the order (or if a dependent is in college, until they graduate). Possible scenario: Joe Doe (Contractholder) and Jane Doe (Joe's former wife and mother of Donna Doe) have both been receiving Donna's EOBs pursuant to a court order. Donna's in college and goes to her OB/Gyn and asks for birth control pills. Donna doesn't want her father to know (he has a temper), so she invokes PC with both the Provider and the insurance company. All of a sudden, neither Joe or Jane are getting copies of Donna's EOB's. Jane knows that Donna went to the OB/Gyn but doesn't get a copy of the EOB. She calls Joe and asks if he has gotten the EOB yet... of course he says no. So she calls customer service. How should the customer service rep answer? Does HIPAA Privacy override the Domestic Relations Order or vice versa? 3) How do you respond to a 12 year old who asks for PC when calling/writing to Customer Service? Do you explain and direct her to go to court to get a court order giving her the right to invoke PC? Do you grant the request absent the court order even though she isn't 18 (or what ever the age of majority/emancipation is in the your state)? We are primarily concerned with inadvertently cluing in a parent/spouse that there has been a PC request, where the contractholder thinks that they have the right to get such information (people can get pretty irate in these situations). We want to avoid the situation where an abusive spouse/parent figures something funny is goin
