Health Protection for Individual Insurance

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 What Is HIPAA?

The federal government established the Health Insurance Portability and Accountability Act (HIPAA) to reform healthcare in America. HIPAA legislation serves numerous purposes:

  • Maintaining health insurance coverage for working Americans with pre-existing medical conditions when they change jobs or lose their job;
  • Reducing medical fraud and abuse;
  • Enforcing health information standards; and
  • Ensuring health information security and privacy.

HIPAA Protects What Types of Medical Information?

HIPAA protects a wide range of information from disclosure, including the following:

  • Financial information;
  • Administrative transactions;
  • Personal information;
  • Health claim information;
  • Program eligibility information; and
  • Health insurance.

Who Must Obey HIPAA Regulations?

Many entities in the medical field must follow HIPAA’s requirements, including pharmacies, physicians, and health insurance providers.

How Does HIPAA Safeguard My Privacy?

HIPAA protects individuals’ privacy by establishing federal rules that ensure the security and confidentiality of patients’ health information. HIPAA restricts the use of a patient’s private medical information by health plans, pharmacies, hospitals, and other institutions.

What Do Medical Health Records Mean?

Medical health records are details about an individual’s medical treatments, diagnoses, surgeries, and other identifying information.

Typically, the individual’s healthcare institution, such as the hospital, keeps these records. Medical records can be very detailed and reveal sensitive information about a patient in specific instances. In general, someone cannot view another person’s medical health records without notifying the patient and receiving their permission.

Can a Person with Power of Attorney Access Someone Else’s Medical Information?

Nothing under HIPAA impacts a patient’s ability to delegate power of attorney for health care choices to another person. The state or local rules governing a power of attorney will continue to apply.

As long as the power of attorney form is valid, it should comply with HIPAA rules without having to add or change anything to the form. When the patient signs the power of attorney for health care, their privacy rights under HIPAA pass to the individual who receives the authority to make health care decisions. The person who receives authority under the power of attorney is the agent, and the patient is the principal.

If a physician or other covered entity believes that the agent is abusing or endangering the patient, the physician or covered entity may decline to provide medical information to them. To do this, the physician or covered entity must show that it is in the patient’s best interests to deny the agent access to the patient’s information.

Under HIPAA, May Information be Blacked Out?

Yes. Under HIPAA, information may be blacked out through a procedure known as de-identifying. De-identified patient data is information from medical records that have been blacked out.

Certain HIPAA laws allow blacked-out or de-identified health information to be given to a third party and used without restriction. This method erases identifiers or information that someone can use to identify an individual, such as their birthdate, household members, employer, and other information.

Does HIPAA Provide Protection to American Workers Who Require Individual Insurance?

HIPAA provides the most protection to new employees who want to join their company’s group health plan. It provides very little protection to individuals who are forced to transition from a group health plan to private insurance.

This mandatory change may occur if your company discontinues health insurance benefits, you quit your employment, or you decide to work for yourself.

HIPAA guarantees you the right to acquire individual insurance coverage without fear of exclusion due to pre-existing medical conditions if:

  1. You have enjoyed at least 18 months of uninterrupted coverage with no considerable gaps (a significant break is more than 63 days).
  2. A group health, government, or church plan provides your most recent insurance coverage.
  3. You are not eligible for additional group coverage.
  4. You do not qualify for Medicare or Medicaid.
  5. You purchased and used all available COBRA, Temporary Continuation of Coverage, or State Continuation Coverage benefits.
  6. A company did not cancel your policy because of nonpayment or insurance fraud.

What Can I Do to Protect My HIPAA Rights?

When you leave your health plan, you can acquire a “certificate of creditable coverage” in writing. Your certificate should include the following:

  • Dates of coverage;
  • Your policy identification number;
  • Name and address of the insurer; and
  • Any family members covered by your insurance.

Do I Have Access to My Own Medical Records?

Yes, a person has the right to inspect their own medical records. In most cases, a healthcare practitioner or any holder of medical records must have specific measures in place to ensure the data contained is not accessible to unauthorized people.

Individuals may seek a copy of their medical records from their healthcare provider or the institution that has the information. The medical record holder must provide the documents to the individual within 30 days.

Although individuals have the right to receive their medical data, it is currently legal for some health care providers or other institutions to charge a reasonable fee for providing a copy of those documents. The cost of the service may vary depending on the healthcare institution and the state.

Does My Employer Have Access to My Medical Records?

An individual’s healthcare provider usually cannot provide any information about their health records to someone’s employer. An exception is if the individual’s employer provides their health care plan. In that case, the employer may have limited access to the individual’s medical information.

An employer can only use this information in connection with healthcare and cannot disclose the data to unauthorized employees of the company.

In a Personal Injury Lawsuit, Can Medical Health Records be Obtained?

One specific question about medical records is whether they can be obtained for a personal injury case. In general, communications between a doctor and a patient made in connection with a lawsuit are privileged or confidential.

That said, there are instances in which someone’s health records can be revealed during a personal injury lawsuit using specific legal procedures.

For example, suppose someone broke their neck in a vehicle accident, and they visit with a physician to estimate the damages. In that case, the other driver cannot access the consultation data without permission from the patient. However, in rare situations, the court may order that the patient reveals this information during the personal injury lawsuit.

What If I’m Involved in a Medical Health Records Dispute?

The unlawful release of a person’s medical health records is illegal. There are many instances in which companies seek out this information for marketing and advertising purposes.

Pharmaceutical companies and insurance firms, for example, may wish to acquire specific information to understand which medications are popular.

These organizations are only permitted to access information in legal ways by following proper procedures. A health record privacy dispute may arise if an entity fails to comply with the legal standards for accessing medical records.

In these types of instances, a plaintiff may be awarded damages for losses or injuries sustained due to unauthorized access to their medical health records.

Do I Need a Lawyer to Resolve My HIPAA Issue?

The interpretation of HIPAA laws can be difficult. A knowledgeable insurance lawyer can assist you in understanding how HIPAA laws protect you.

Suppose you suspect your health insurance company is operating in bad faith and wrongfully refusing you coverage. In that case, an attorney will be familiar with the intricacies of dealing with a large health insurance company.


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