HIPAA resulted in numerous changes to how the health care industry handles medical and personal information. One key change is to make it harder, or in some cases illegal, for someone to access a member's medical records just because they were curious. That helps protect the member. Another benefit to HIPAA is the further discontinuance of preexisting conditions. In this issue of HIPAABlues, we discuss portability and why "curiosity can kill a cat" if you decide to peek at someone's medical records.
It's My Family...Why Can't I Look Or Ask?
In the past, it was possible that family members, who work for a health plan, might help a family member resolve a claims payment issue, to check on an approval status, or even to review charts of a loved one in the hospital. This sometimes extended to friends and even family members of friends.
It wasn't perceived as a problem by the employee since they felt that verbal approval was enough. HIPAA changed all that and now this practice is a "no no".
With the implementation of Privacy and Security policies, processes, and system changes, it is illegal to view someone's Protected Health Information (PHI) if it is not your job or if you have not been identified as an Authorized Person or Personal Representative. Even if you are classified as such, you do not have the right to simply access the information.
Access controls were put in place to safeguard a member's PHI. Part of this includes locking down systems so that an employee can only access the information or systems appropriate for his or her position. The days of everyone having access to claims and enrollment systems (or billing for a provider) are gone. If it has nothing to do with your job your access is gone.
Furthermore, if you have access to these systems it will not be full access. An employee will only have approvals to see sections or use functionality appropriate for their job. These are additional safeguards designed to protect you.
So, while it may have been easy to call your nephew, son or neighbor and say, "hey...can you help push xyz along?", it can no longer be done. This may sound inconvenient, but it is for your protection.
Don't Forget Portability
When HIPAA was first introduced as legislation, it was not originally about Privacy or Security or even National Identifiers. When the Clinton Administration began HIPAA is was designed to ensure that Americans could maintain their health care benefits if they switched jobs.
Prior to that, many health insurers would label you as having a preexisting condition and not cover your pregnancy, cancer treatments, etc.
The government decided to act and introduced legislation on Portability, which is what the "P" stands for in HIPAA.
It was during the rule making process that other legislators introduced administrative simplification, safeguards, and member rights as well as all the other technical, administrative and physical requirements that have resulted from HIPAA.
So, if you have ever become frustrated by what some view as "HIPAA roadblocks," think about what you or your friends or loved ones had before if they had a preexisting condition. Now, it is much better for them and everyone.