HIPPA and medical bills? UPDATE

[slsh]

Ins co is refusing to discuss psychiatric claims on thank you with- me because he's over age of consent for MH in IL (12). I have to either get an authorization from him (give me strength) or send them copies of tx plans, IEP's, and Residential Treatment Center (RTC) admission report (so much for privacy, not going to happen).

I am simply beside myself right now. This insanity is just never going to stop. Suggestions?

 

[Sara PA]

Get an authorization from your son. Get them for any contacts he has if you can. Just write up a letter authorizing you to give and receive information from the insurance company about his treatment and ask him to sign it. Tell him you need it to pay the bills, that it's a business thing..which is the truth.

My son has been signing these for years, even for me to give and receive information from his last psychiatrist.

 

[slsh]

Sara,

You're assuming he'd sign it.

I'm the parent, guardian, and responsible party. He is a 14 y/o child, and a severely mentally ill one at that. He is *incompetant* to give consent, much less understand what this is all about. I will not set a precedent of needing his "authorization" to insure that he is taken care of.

 

[slsh]

TM - there's the dilemma. I'm already his guardian by virtue of having given birth to him 14 long years ago. I don't lose guardianship until he hits 18, at which time we file in court to retain guardianship due to the severity of his disability. At that point, I wouldn't be having this problem, but in their infinite wisdom the lawmakers have put parents of mentally ill teens between the ages of 12 and 18 into complete and utter limbo.

I may have found a loophole or two - who'd have thunk I'd be spending a lovely summer afternoon reading IL statues. First of all, a minor has to be *16* in order to sign himself into a hospital without parental consent. For outpatient, the age is 12, but they can only have five outpatient sessions before parental consent is required.

Secondly, insurance company is requesting confidential information that I do have access to because, obviously, I am his guardian (duhhhhhh). They are in essence *violating* HIPPA in order to enforce it. My morning reading tomorrow will be the actual HIPPA law (since it seems it will be a thorn in my side for quite a long time), highlighting the appropriate passages and then advising my insurance company that they can either deal with- me or deal with- an OCR complaint (and what genius put OCR in charge of HIPPA???)

I have called my state senator and rep, the atty general, the advocacy and guardianship office, Office of Consumer Health, IL insurance Hotline, and OCR. Tomorrow I'm calling the IL Dept of Mental Health. The really sad/funny thing is that no one believes me when I tell them the age of consent in IL is *12*. The ladies in both my rep's office and the atty general's office were I think genuinely appalled at this bologna.

Another thought is just to have thank you call the insurance company.... bwa-ha-ha-ha. Wouldn't that be the conversation...

Sue

 

[Sara PA]

Originally posted by slsh:
[qb]Secondly, insurance company is requesting confidential information that I do have access to because, obviously, I am his guardian (duhhhhhh). They are in essence *violating* HIPPA in order to enforce it. My morning reading tomorrow will be the actual HIPPA law (since it seems it will be a thorn in my side for quite a long time), highlighting the appropriate passages and then advising my insurance company that they can either deal with- me or deal with- an OCR complaint (and what genius put OCR in charge of HIPPA???)[/qb]

Now wait, now wait.........the insurance company is requesting information from you while refusing to give you information???? LOL Tell them to call thank you or produce a release allowing you to discuss thank you with them. It would seem that door should swing both ways. They want to eliminate the parent, let them deal with the "adult" child.

 

[slsh]

Clarity, finally.

HIPAA prohibits release of info to parent if minor consented to tx and parental consent is not required, tx is court ordered, *parent* agrees to confidential nature of minor's relationship with- provider, or state law prohibits it.

IL state law requires only that minor between ages 12 and 18 be "informed" - nothing in writing - of the sharing of information. There is no prohibition on the sharing of information with- parents; in fact, there is a *guarantee* that parents are advised of tx, diagnosis, medications, etc. Minor of course has the option to object, but *minor* must then appear in court to get judge to agree with- objection. Per the law professor and mental health policy guy at U. of C. I spoke with- today, the age of consent of 12 really *doesn't* limit parental rights and consent in a practical way, because the onus falls on the minor to appear in court to refuse tx/medications, and we do *not* have to assist said minor in that endeavor.

Long story short, called ins co back and advised her that the IL statute she was quoting had nada to do with- confidentiality, but I could direct her to the one that does. Blah blah blah, let me get back with- legal dept.... and she returns call and is oh so helpful in getting claims reviewed and paid, LOL.

:Warrior: strikes again. Can I get AP credit for this junk when I head off to law school???? :wink:

Sue

 

[Reenie]

I've had similar problems with my insurance company. HIPPA does not allow them to release any information to me. It has nothing to do with whether I am the patient or my child is.

In our case, my daughter sees a pediatric endocrinologist for polycystic ovary. The endo put down a preliminary diagnosis of hirsutism (excess female facial and body hair), which is considered a cosmetic problem. The insurance company refused to pay, but would only tell me that it was because of the diagnosis code. They wouldn't tell me what the diagnosis code was. I was stuck in the middle trying to get the doctor to update the diagnosis code.

Unfortunately, this has happened multiple times. The last time was on the labwork. I had to get the doctor to send an updated diagnosis code to the lab, and then they had to submit the correct code to the insurance company.

The insurance company can't simply call the doctor to ask for the correct code. I have to do that. And it usually takes multiple requests. I have started communicating with doctor and insurance company by email or fax only so I can document everything.

If she wasn't such a good doctor and doing a great job treating the PCOS, I'd switch.

 

[bigblueagain]

I know you all get tired of me probably in taking the other side to these issues.....BUT once again I need to give the other side of the issues since I work the other side, and have for many many years. HIPAA was developed and made law by lawmakers... lay people, not medical or people with previous billing experience. It was initially a good idea....to allow employees to have continued coverage when either laid off, fired or changing jobs.(Health portability Act (HPA) It was also good from the stand point that if those employees could show continuous coverage when they applied for new or different coverage they could no longer be denied coverage for things which were once considered PRE-EXISTING. (Which I admit most insurers could explain everything at one time or another as pre-exisiting and did....ESPECIALLY mental health issues.). Then the lawmakers due to consumer urging decided to tack on the information privatization part. In large part I believe to slow the claims paying process down in order to make insurers pay for treatment whether it was medically necessary or not...this was after the HMO's came into play and required precertification prior to most everything. Instead of allowing them to get info on the front end, as there were things being denied that truly did NOT meet medical necessity and that made the ever wanting American public crazy, it is now difficult to get that much needed information, even on the back end once treatment has already been rendered. As with most public policy the HIPAA law is cumbersome and undefinable. (Ever see the Medicare REgs???)
It has caused most insurers to add personnel just to try to figure out what it means. Most insurers have had to add a HIPAA compliance officer. Most insurers have also had to consult out to computer, risk management and security firms just to mention a few to come into compliance, although every time we call for clarification to the very entities that are supposed to know and understand the law, it is a different answer each and every time. It is bogged down under state law as well, which means additional staff is needed to keep abreast of the local law. This has added cost to your employers premiums, which folks is being passed on to you and me. Also as pointed out, a lot of the problems lie in the fact that most physician offices now have hired billing practices to bill and collect their payments. Folks, you don't even want to know what we see from those folks. They can get their training over the internet, and many do. Many do it from their homes, which may not be the most undistracted environments to start with.
All I can say is that of ALLL the different types of insurance companies, third party administrators and ppo's I've worked for really do try. However when you get government involved in no matter what the situation (and I believe this with the NO Child Left Behind laws as well) and you don't include the very people who work the system it is going to bog down. You just have to be patient and do a paper trail just like with the school systems.
BLUE