HIPAA, HIPAA, HIPAA.....Oh My!!!!

By now, everyone has probably heard about HIPAA, and have an understanding of what it stands for. If not, it's an acronym for Health Insurance Portability and Accountability Act, which is the federal law that protects the privacy of personal health information. 

Did you know, that if you were to work in a medical office and violated the HIPAA law, that both you and your employer could be fined up to $250,00.00 each if you were proven guilty of violating this law? Which brings me to three personal stories of violation of HIPAA that happened within my own family. 

     A close relative had a suspicious mammogram and ultrasound and needed a breast biopsy.  There was a lot of mis-communication with the doctor's office ordering the test, and the radiology office where this test was to be preformed. Another relative has written permission to speak with medical providers on the patient's behalf. A good week has gone by and no one has heard from the radiology office. The patient calls and is told that they will call her after certain parties have reviewed the referral and prior films to determine what needs to be done. They will call her back the next day. Nothing happens. Another few days go by. The relative calls the radiology office and when she gives the patient's information; not only does she give the wrong birthdate, but the receptionist corrects her!  UGHHHH  As soon as incorrect information was given, the correct information SHOULD NOT have been volunteered by the radiology staff. I don't even believe that they verified that "the relative" had permission to speak with them either. 

     Violation #2.  This one personally happened to myself recently.  I needed to get copies of my shot records for MMR and Chickenpox, as I am going to be doing some volunteer work at a hospital. I called the medical office where I had the vaccinations, but didn't expect much as I hadn't been there in over twenty years. I knew it was a long shot that they might have records on me still, but I thought I'd give it a shot.  I called the medical records department and gave them my name. They couldn't find any records on me, (no surprise there), but did volunteer the names of my mother-in-law, sister-in-law, brother-in-law and two neices that are still patients there. I knew that all of these people went to this clinic, but the medical records clerk didn't know that I knew this. She should have never given me their names. She should have merely said, "We don't have you in our system anymore", and left it at that.

Lastly, another realative saw a physician and he ordered a blood test. He sent the order to the printer, and handed it to her. She took it to the lab, and looked to see what he ordered. Ummm, he forgot to check the name on the order before he grabbed it off the copier, and just handed her the first one he grabbed; which belonged to someone else! She handed the paper to the lab tech, and told her it wasn't her. The lab tech was able to get her order and do the correct lab work, BUT she folded the wrong order in half and asked my relative to take it back to the doctor.  OOPS   She should have just taken care of it herself!

I realize that HIPAA is still fairly new, but by now health care workers should have had it drilled in long enough to be uber-careful about it! Let's hope things happen in three's, and this won't happen again to any of my family members or you and your family.




You can read more of my posts about insurance on my blog at http://healthclaimshelp.blogspot.com/

Helping my Daughter with her EOB's/Bills

I recently went to visit my daughter in North Carolina, where proceeded to hand me a stack of medical bills.  She couldn't make heads or tails out of them. One of the "bill's" was actually a statement from her insurance company showing total charges (for 2015), adjustments, payments and her balance. All she saw was the first number, $1632.00 and freaked out!  She thought she owed this. I took everything back to California with me and told her I would sort it out.

First, I went to her insurance website, logged in and matched the bills with the charges.
Next, I made sure there were no "missing" bills.
Then I verified that the billed amounts due from her, were correct with the EOB's online.

Doing this, I found that one item on one of her bills had been denied by her insurance company.  It looked like it was rebilled, yet, I didn't have a bill for it.  The balance according to the webite should have been $25.45.  I called the billing office to pay this. Since I wasn't the patient, (HIPPA privacy law), I had to have my daughter call and give the medical billing office permission to speak with me. The balance that I saw that was due was for an office visit copy ($25.00) and co-insurance $.045. This was for a February visit, but had just been paid by the insurance company in May. When I spoke with "Tianna", she stated the balance was $41.25,  She indicated that the balance was past-due and sent to collections, so had fees added to it. This infuriated me! Just because they billed incorrectly and didn't get payment for 90 + days, they figured my daughter was in arrears. I asked to speak with a supervisor, as it wasn't my daughter's fault that they billed incorrectly. In a nutshell, I got this bill taken out of collections (it was just submitted the end of May), and only owed the original co-pay. 

In conclusion, always look over your bills from your providers and match them up with the EOB's you get from your insurance company. If something doesn't seem right, call right away.  Don't wait until it's too late and your providers place you in collections. Hopefully my daughter has learned a lesson from this!


 

When a Spouse Passes away and the insurance was under his/her name (Obama Care)

One of my good friends (I'll call him Mike) passed away in September from cancer. It was quick-coming, and unfortunately, my friend didn't didn't share with his wife how their health insurance was set up. His spouse (I'll call her Joan) has had nothing but problems with her health insurance (not to mention other things), since his passing.

Mike and Joan were self-employed, live in California and have "Covered California" (Obama care) health coverage. Mike was the subscriber, so any changes to the plan had to be done under him.  Now here's where it gets ugly. When Mike passed away, Joan tried contacting her insurance company to cancel the plan and get on her own plan. Since her social security number was tied up to Mike's plan, this was impossible to do. She even tried going on the Covered California webite to do this, but unfortunately Mike hadn't shared his user name or password with her.

Joan went phyically and talked with insurance agents. All they did, was give her misinformation. I even tried to help. I did an online chat with Covered California and they gave me some steps to try. First off, Joan was to fax (and she also mailed) them a copy of Mike's death certificate. This supposidly would flag their account and give Joan a special circumstance to start up new coverage. She did this in November, and is still getting bills/premiums for Mike. Hopefully, she'll start calling them and bugging them everyday until this gets resolved.

The purpose of this is to let you know that spouses need to share account information and passwords. Had Joan had this, she would have not gone through the extra stress that it's taken on her to get this sorted out.  This doesn't pertain to just health insurance, but bank log-in information, credit cards, On-Star (another one she's having problems with), life insurance documents, etc. Absolutely anything that you can possibly think of that a surviving spouse may need to know about in the event of an umtimely death. 

Had Mike done this before it was too late, Joan would have been able to have one less thing to have to worry about and deal with.