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Does ERISA law cover insurance/pharmacies revealing your specific health info to your self-insured employer? |
Info including patient's name, diagnosis, prescription names, strengths & even the pharmacy where they were filled at? I'm not having much luck under the HIPPA law being enforceable. No, ERISA doesn't regulate privacy. HIPAA is the correct law. Health Insurance Portability & Accountability Act. It depends on how they're getting the info, and what they're doing with it. Some laws vary from state to state, so check the laws where you live... Typically, your employer isn't allowed to know your PHI, without your written or verbal consent. They can find out overall, how many employees have a certain diagnosis, or how many people had a certain procedure. (like tracking costs, and most service provided, etc) But, your individual info should be protected. Are you spelling HIPAA wrong? Its HIPAA, not HIPPA. Try searching yahoo with HIPAA privacy law employer & your state name. You have tons of options regarding the protection of your info. You can file a privacy complaint with your insurance. You can request that your insurance company provide you with documentation showing each time they disclosed your PHI, and to whom it was disclosed. Why's your employer asking for your information? And, why is it being disclosed without your consent? Most info on the web is going to be listed on your insurance company's web site. Try there first. Source(s): wk in insurance 10+ yrs Actually, I disagree with part of what the previous poster answered... if your company's health insurance is self-insured, then they MAY have detailed information regarding the payment of your claims (doctor's office or prescription). The HIPAA Privacy Act (Title II) regulates that while the Employer is NOT entitled to this information it MAY be disclosed to the Health Plan (yes, the government sees the health plan as separate & distinct from the employer) for the purpose of paying medical claims. Self-insured health plans are to draw a very strict line between information received from a medical care provider and who at the employer has a legitimate "need to know." Every privacy policy I have ever read allows for acceptable disclosures of PHI for: 1) treatment of patient and 2) payment of medical expenses. For example, if your self-insured employer has 2 employees that are assigned the duty of reviewing claims and processing the appropriate payments, these 2 folks would need to have very complete data regarding the ICD-9, CPT or HCPC codes billed by the doctor, pharmacy or hospital. They should also be required to keep this information extremely confidential and not share it with the patient/employee's manager or supervisor. Also, depending on how the self-insured plan is structured the PHI disclosures may be required to authorize high dollar items like (non-emergency) surgeries, MRI, CAT scans, experimental treatments, etc. Some self-insured plans have added features that may be used to help contain costs for the plan trustees as well as for the patients -- things like having a health care educator contact patients who receive a new diagnosis of diabetes or other chronic conditions to help them learn how to best manage their own situation. Many self-insured plans hire a Third Party Administration company to review claims and process the payments. However, the TPA will periodically send lists of checks to be cut from the employer's bank account which will usually include patient names so that the medical provider can credit the proper accounts. Keep in mind that this check listing should not disclose anything more than patient name, date of service (maybe), medical provider and the amount being paid. The rule of thumb to follow is "minimum necessary." It's a tricky thing. Below is the Health & Human Services website to look up information on HIPAA. http://www.hhs.gov/ocr/hipaa/ Good luck 10+ years in HR / Benefits including working with self-insured health plans. No law prevents mandatory disclosure of the data required to determine whether a claim is legitimate and all the information you're complaining about is required. |
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