I would really love to hear everyone's response to this. This is an issue we are trying to address. Who can we talk to about PHI? Only the member? The subscriber for all the member's under him (Which seems to be an industry standard)? We are trying to have as few "exceptions" or opt-outs as possible. Otherwise it makes life very difficult for member services when someone calls. (Multiple places to check for exceptions and multiple opportunities to make a mistake).  
Any advice anyone can give would be appreciated.

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]

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-----Original Message-----
From: dale pocklington [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, January 14, 2003 3:41 PM
To: WEDI SNIP Privacy Workgroup List
Subject: Parent Inquiries and HIPAA

I have a privacy related question that I just can't seem to find a specific answer for. I am dealing with a TPA/Broker type environment that has about 80% of the calls from non-providers whose parents are calling on behalf of their adult college-aged children. This is probably because the students either don't understand the insurance process, don't have time to handle their claims, or because the parents still handle all the child's finances. The nature of the calls are everything from claims payment status to inquiries about problems. I can't find anything in the HIPAA privacy regs. that specifically addresses this issue. Mostly, I have found language regarding being a "personal representative". However, that seems to address minor children, or situations where the parent has some sort of legal authority over an adult child.

My question is, under HIPAA, is there any sort of language or interpretation that allows/covers the above situation whereby we do not have to get the insured's consent to discuss his or her claim with their parents?

Dale W. Pocklington, MS, MHA, CDIA, CCA

 



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