Any experience with Dr. not completing insurance form due to HIPAA violation?

[Zoey]

In August I booked a cruise for my 80 year old parents, which was actually supposed to begin tomorrow. Later, when my work calendar freed up a bit, I decided to book myself on their cruise, not tell them, and show up and surprise them.

 

Because of their age (they are in excellent health) I purchased them a good trip insurance policy, which cost close to $350 for the two of them. After I booked mine I also bought a different policy for myself with a different company than theirs. Mine did cover immediate family emergency situation cancellations.

 

Well, of course, 10 days ago my mother fell and broke a hip. She did undergo surgery and was hospitalized for three or four days. She is now getting PT at home. I cancelled their cruise a day or two after the incident. When I saw how necessary it was going to be for me to help take care of her (shopping, some cooking and cleaning, etc.) I cancelled mine.

 

At her orthopedic surgeon's office this morning, they completed the insurance company Physician's Authorization form for HER insurance but refused to fill the form out required by MY insurance company because they said it "violates HIPAA regulations." My mother offered to sign any form at their office to allow them to complete the form but they still wouldn't.

 

I would not have even told them about my surprise if it wasn't for the fact I needed my mother to get my claim form filled out by the doctor. She cried when I told her.

 

I placed a call to my insurance provider a little while ago, was on hold for 20 minutes, then cut off. I then sent an e-mail and received an automated response that they would get back to me within the next 24 to 48 hours. I asked them if a copy of the physician's form the doctor's office completed for my mother's insurance company could be substituted for theirs. I'm not sure they'll go for that. I also asked what the alternative is in a situation like that.

 

I intend to call them again in a bit but wanted to try and get any responses from others first that have experienced similar occurrences and how it may have been resolved.

 

Anybody???

 

Thanks.

[GeezerCouple]

In August I booked a cruise for my 80 year old parents, which was actually supposed to begin tomorrow. Later, when my work calendar freed up a bit, I decided to book myself on their cruise, not tell them, and show up and surprise them.

 

Because of their age (they are in excellent health) I purchased them a good trip insurance policy, which cost close to $350 for the two of them. After I booked mine I also bought a different policy for myself with a different company than theirs. Mine did cover immediate family emergency situation cancellations.

 

Well, of course, 10 days ago my mother fell and broke a hip. She did undergo surgery and was hospitalized for three or four days. She is now getting PT at home. I cancelled their cruise a day or two after the incident. When I saw how necessary it was going to be for me to help take care of her (shopping, some cooking and cleaning, etc.) I cancelled mine.

 

At her orthopedic surgeon's office this morning, they completed the insurance company Physician's Authorization form for HER insurance but refused to fill the form out required by MY insurance company because they said it "violates HIPAA regulations." My mother offered to sign any form at their office to allow them to complete the form but they still wouldn't.

 

I would not have even told them about my surprise if it wasn't for the fact I needed my mother to get my claim form filled out by the doctor. She cried when I told her.

 

I placed a call to my insurance provider a little while ago, was on hold for 20 minutes, then cut off. I then sent an e-mail and received an automated response that they would get back to me within the next 24 to 48 hours. I asked them if a copy of the physician's form the doctor's office completed for my mother's insurance company could be substituted for theirs. I'm not sure they'll go for that. I also asked what the alternative is in a situation like that.

 

I intend to call them again in a bit but wanted to try and get any responses from others first that have experienced similar occurrences and how it may have been resolved.

 

Anybody???

 

Thanks.

 

As I'm sure you know, "the patient" CAN authorize a medical provider to disclose certain specifics to *anyone*.

 

I don't know if the staff at their doctor's office are confused or just being uncooperative (but why?).

 

Perhaps you could FIRST go ahead and send in your parents' medical insurance claim forms completed by the physician with your claim, with an explanation (one that also might bewilder them!).

Then you'll have started filing the claim in a timely manner.

 

Then IF that's not satisfactory, you could have your mother call her physician's office, with you nearby, and tell them that you are bringing over a letter of permission to complete the entire medical form, and that she expects them to do so.

 

(It would be a different problem if the patient didn't want to disclose the info, but at least you aren't in that situation.)

[Zoey]

As I'm sure you know, "the patient" CAN authorize a medical provider to disclose certain specifics to *anyone*.

 

I don't know if the staff at their doctor's office are confused or just being uncooperative (but why?).

 

Perhaps you could FIRST go ahead and send in your parents' medical insurance claim forms completed by the physician with your claim, with an explanation (one that also might bewilder them!).

Then you'll have started filing the claim in a timely manner.

 

Then IF that's not satisfactory, you could have your mother call her physician's office, with you nearby, and tell them that you are bringing over a letter of permission to complete the entire medical form, and that she expects them to do so.

 

(It would be a different problem if the patient didn't want to disclose the info, but at least you aren't in that situation.)

 

I KNOW my mother doesn't like to cause waves and is probably not being forceful enough with them. She understands the situation I'm in and gladly signed a medical records release for both her insurance company and mine.

 

Although I'm not wealthy, if I had only paid several hundred for my cabin, I may let it go just to not have to deal with the headache of the claims process, however, I booked a solo cabin, with balcony, and it was getting close to the $2,000 mark. Plus I booked a one-way ticket to the cruise port because I was going to drive home with them - helping my father with the driving.

 

I guess before I take any more action, I'll wait and see what kind of hoops the insurance company tries to make me jump through.

[cruiseco]

You're correct in that if you're cancelling due to an injury/illness of another person your insurer will need the medical claim form signed by the doctor of the ill/injured person. I've never seen one family member not give that permission for another family member to file a claim but I'm sure it's happened. I've never seen a doctor refuse something in writing from the patient authorizing the info to be given to so-and-so but again I'm sure it's happened. I think the Doctor's being overly strict on his/her interpretation of the law. Your mother will probably have to contact him directly (the problem may be coming from an office manager or someone) and insist the records be disclosed. I think the records are hers to disclose to whomever she wants -- that call is not the doctor's to make. Good luck. The doctor needs to be slapped upside the head by your Mother

[CaptnG]

It makes no sense to me what so ever, absolutely not a HIPPA violation. I would ask again and when they refused mention that you'll be calling OCR (office of civil rights) as they field all HIPAA complaints and see what they say then. Triggering an audit from OCR could lead to some very big consequences for the practice, because they obviously have very little understanding of the rules. I'd also ask to see their policy that addresses release of information, if they don't have one that's another HIPPA violation that would likely trigger an audit if you call OCR.

http://www.hhs.gov/ocr/filing-with-ocr/

Good luck!! I hope you're able to get this resolved soon so you can plan a new cruise for when your moms back on her feet.

 

 

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[janrey1234]

What about asking her primary care physician to fill it out?i am sure he or she is aware of your mothers condition.

[cruiseco]

What about asking her primary care physician to fill it out?i am sure he or she is aware of your mothers condition.

 

If he/she is not the actual doctor treating the cause of the cancellation the insurer probably will not accept it.

[GeezerCouple]

It makes no sense to me what so ever, absolutely not a HIPPA violation. I would ask again and when they refused mention that you'll be calling OCR (office of civil rights) as they field all HIPAA complaints and see what they say then. Triggering an audit from OCR could lead to some very big consequences for the practice, because they obviously have very little understanding of the rules. I'd also ask to see their policy that addresses release of information, if they don't have one that's another HIPPA violation that would likely trigger an audit if you call OCR.

http://www.hhs.gov/ocr/filing-with-ocr/

Good luck!! I hope you're able to get this resolved soon so you can plan a new cruise for when your moms back on her feet.

 

 

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I think this is an excellent suggestion, all of it.

 

But IF you decide that it warrants "reporting", then make sure that either the physician him/herself and/or the office manager is explicitly told about this next step.

It would be nice to avoid that route.

 

Also, don't wait too long.

Make sure you are aware of all deadlines for travel insurance claims.

 

What you were told is so absurd, that it almost needs to be from someone who is truly clueless (or just lazy??).

 

Medical offices are well familiar with "releases"... for other treating physicians/therapists, insurance payments, disability claims, and who knows what else.

[LDVinNC]

Please keep us posted of your progress with this matter. I hope your Mother recuperates quickly!

[Hlitner]

As one who used to be (before retirement) the HIPAA Compliance Officer (among other things) for a large State Government Medical Insurance Provider...I can say that the OP is doing all the right things. And my advice is keep pursuing your insurance company for a solution (and keep a written log/record of your exact stops).

 

As to your Surgeon's Office, if they are part of a large group and that group is owned by another entity (such as a Hospital system) you are likely dealing with office employees who simply do not have the internal authority (or training) to deal with your issue. But every organization does have one person somewhere (it was me for an organization of thousands) who can deal with your issue. But getting to the proper person can be an exercise in futility...especially if your physician's office staff has no clue. They are simply doing as they were trained. And many organizations put the fear of God into staff about HIPAA and the penalties for a violation.

 

And yes, folks, this is the kind of thing that happens when government gets involved in Healthcare :(.

 

Hank

[klfrodo]

And yes, folks, this is the kind of thing that happens when government gets involved in Healthcare :(.

 

Hank

 

Off topic, but I'm with Hank here.

 

Don't like the healthcare system we had? we changed to Affordable Healthcare Act (Obamacare/Romneycare), don't like that and would prefer a Single payer system (true Gov't healthcare)?

We've already got one of the largest fully Gov't run healthcare systems in the world here in the good ole US of A. It's called the VA Healthcare System.

Coming from a disabled vet,,, be very careful what you ask for.

[Hlitner]

Off topic, but I'm with Hank here.

 

Don't like the healthcare system we had? we changed to Affordable Healthcare Act (Obamacare/Romneycare), don't like that and would prefer a Single payer system (true Gov't healthcare)?

We've already got one of the largest fully Gov't run healthcare systems in the world here in the good ole US of A. It's called the VA Healthcare System.

Coming from a disabled vet,,, be very careful what you ask for.

 

Not to get hung up on the details, but HIPAA does pre-date Obama Care by a few years (1996). HIPAA is a greet example of a very well intentioned law (to protect the public's privacy) that became a bit of a monster once the "Fed" started writing thousands of pages of enabling regulations. The Affordable Care Act, on the other hand, is possibly the worst written piece of Legislation I ever saw in my entire long government career. and many of the worst provisions are just now coming home to roost and even shocking the Democrats who voted for it (before they read it). Come to think of it, I doubt if many in Congress have still ever actually sat down and read the act

 

Hank