<p>My husband just called me from the Doctors office where he is waiting for an appointment. The receptionist pointed out to him that our daughter had an outstanding bill from late last summer. She got one or two immunization shots there before she went to China and thought that her insurance would cover it. </p>
<p>I believe we did get a bill from the doctor’s office and I think I forwarded to my daughter in China along with some other things in the fall but I’m not sure. It may be upstairs in her room with other mail that is for her. She may have paid it.</p>
<p>Here’s the thing, our daughter is not a minor - she’s about to turn 23. She went in to the doctor’s office with her own insurance card, not our family plan. I don’t think they should have mentioned this to my husband at all. At the library where I work we don’t even connect people’s accounts if they are over 16 and never, ever, ask for a spouse to pay for their own husband or wife’s balance. They can certainly pay it if they know about it and ask but we don’t see it and don’t mention it.</p>
<p>On the other hand, we do live in a small town and they may have thought they were doing us a favor because it would be bad if this was given over to a collection agency and put on her credit report. But still… Just doesn’t seem right.</p>
<p>For better or worse, this sounds like it’s due to living in a small town. If you all go to the same family doctor, and you’ve all been going for a while, they just view you as one big family. They seem to have all these forms now, too, that you must initial some line if you don’t want any information (medical or otherwise, I guess) shared with anybody. If you don’t initial it, then I guess they feel free to share information.</p>
<p>Here’s my deal with doctors. They often force (or, certainly, strongly encourage) you to have all these tests done if you have an annual-- even something as minor as a blood test. So you take time out to make the appt and have whatever it is done; your insurance (or, more accurately, you) end up paying for it. But to get a copy of the test results?? You may as well be asking for the moon. I’m amazed at how difficult they make it for you if you want a copy of your own test. Patients can eventualy get those copies, but it’s not easy. I find that unnecessary and offensive.</p>
<p>Concerning medical confidentiality: That does sound like a small town issue. Most parents should consider having their college kids sign a medical proxy. If there is a serious issue, parents may not be notified or have ability to help.</p>
<p>Concerning lab results: Most doctors will provide lab results and most are also reluctant. It takes medical training to be able to interpret results. It is common to have results outside of the normal range and this can needlessly upset a patient.</p>
<p>Janieblue, I get a full copy of the test results after my annual physical. The results are attached to a “state of your health” letter my doc sends to me. It must be a choice of each practitioner.</p>
<p>My family doctor’s office sees three generations of my family. I have some serious health issues and am sometimes hard to reach. Whenever there is a problem, the doctor’s office will call either my mother or my husband to hunt me down. I feel fortunate that they do, but I wouldn’t want billing issues to be discussed with my mother, if that makes any sense.</p>
<p>no falling off chairs when you read this, but our doctor’s office now has a system where patients can access their own charts (read only) from their own computer, so when test results become available, we can go in and check them ourselves.</p>
<p>Just had my physical last week, and forgot to talk to the person who handles signing up, but will do it soon. Otherwise, I always get a letter in the mail with results within a week of my visit.</p>
<p>I understand your concern - but it seems to me that the md office was just mentioning the unpaid bill as a reminder - and nothing more. As you said - you live in a small town - and it is not unusal for something like this to happen (live in small town also :)).</p>
<p>A nice response may have been to inform them that she is not on your insurance - that she is the responsible party - not you - and that you will pass the message along - and that they can send the bill to your daughter (again) - since it is her responsibility to pay it - (unless you have agreed to do so).</p>
<p>I don’t feel that it is a breech of confidentiality - as they didn’t discuss her medical status - but I would take it as a reminder that $$ is owed to them.</p>
<p>Pass the info along to your gal and let her take care of it - would be nice also to maybe let the md office know that she is out of the country and it may take a while for her response.</p>
<p>I do see it as a breach of confidentiality. The D is not a minor, and her bills and immunizations are none of her parents’ business unless the D chooses to tell them. Suppose the D hadn’t wanted her parents to know she went to China? Small town or not, the receptionist should have contacted the D, not her parents.</p>
<p>Keep in mind, too, if the D is in China and the doctor’s office knew that, they could have waited for the D’s return so as to let the D know about what she needs to pay. No need to send the bill to a collection agency. No need to contact her parents.</p>
<p>I agree with the small town atmosphere. They probably thought they were doing you a favor letting you (H) know she had a balance. And to be honest, if she had ever been a patient treated there as a minor, and/or as a covered member under a parent’s policy, and if staff had been working there for years, it could happen easily.</p>
<p>With regards to the HIPAA and privacy laws, they cover confidential medical care, but there are exceptions when it comes to the billing of such. And if your H had ever been the responsibile party in the past, it was not an infraction to comment about a past due bill, even if he is not longer the responsible party. And if her address or phone number as listed in her chart is the same as yours, it is not improper either. (Esp if she is in China and you are getting some of her mail.)</p>
<p>I practice in a small town, and have a practice that includes up to 4 generations of the same family. I would hope that it would never get to the point where I would see great-grandma in the morning, and not be able to say anything at all to granddaughter who happened in that afternoon. Now, if greatgranddaughter was there getting BCP’s or STI testing, I would not say a thing…until greatgrandma first said "I think you saw my GGD today, and then it would be OK for me to smile and comment on her new haircut. And that would be that.</p>
<p>Edited to add: If the D did not want anyone to know she went to China, she should be getting her care from a stranger out of town. Her being in China would not be a detail covered by HIPAA actually, and any one of a number of folks sitting in the waiting room might pick up on the details of her trip, anyway. Her getting the immunizations for China would be covered, but not the fact that she is in China. Who is going to go to China and not tell their parents, anyway. Not someone living in my small town who comes to see the family’s doctor.)</p>
<p>Washdad: Well, I eventually get the results if I ask (again and again). In my experience, they always make the retrieval of any tests extremely difficult, though…</p>
<p>I understand that they might like to explain any results to a patient, so that he or she doesn’t become alarmed if something isn’t in the “recommended range;” right after the explanation, though, copies should always be given to patients, in my opinion. And it simply makes good sense for the patient to have copies of any test results, for many reasons. I also take issue with the idea that it takes “medical training to be able to interpret results.” For many tests, that’s not really true. I can read and understand what a bone density test means; I can understand what a complete blood panel means (and if I can’t, I can always look it up). I know doctors don’t like to hear it, but it really does not take a medical degree to understand the results of some of these tests. Truly.</p>
<p>teriwtt: Wow, that’s great, and certainly progressive. I’m impressed.</p>
<p>“Edited to add: If the D did not want anyone to know she went to China, she should be getting her care from a stranger out of town. Her being in China would not be a detail covered by HIPAA actually, and any one of a number of folks sitting in the waiting room might pick up on the details of her trip, anyway. Her getting the immunizations for China would be covered, but not the fact that she is in China. Who is going to go to China and not tell their parents, anyway. Not someone living in my small town who comes to see the family’s doctor.)”</p>
<p>Sorry, but I disagree. People do all sorts of travel that they don’t want their parents to know about, and they should be able to go to the doctor to get required immunizations without fearing that the rest of the town would know.</p>
<p>Also, the fact that the doctor’s office didn’t charge her immediately for the immunizations indicates to me that they thought the immunizations might have been covered by insurance. They could have checked with the insurance then. </p>
<p>And why should anyone in a waiting room know that a person is there to get foreign travel immunizations unless the person chooses to tell them?</p>
<p>The doctor’s office also could have sent the patient a bill, which very likely would have been forwarded to her address in China. (Presumably she has someone forward important mail).</p>
<p>My husband brought home the bill. I probably wouldn’t have thought too much about it if it had not been for the fact that we bend over backwards at our library regarding privacy issues. </p>
<p>As far as we know our daughter could have paid this - we have no access to any of her financial information. Think of it this way - as an adult, I would not want my mother to find out that I had an unpaid bill and have her given a copy of the bill. My mother is exactly the same age older then me as I am to my daughter. </p>
<p>This is not a doctor that knows our family well. One of us will go in maybe once a year and he has to read our charts to see who it is. Fortunately for all, Daughter is coming home unexpectedly (her contract is for a year, ending in August) for a couple of weeks during her vacation period so she can clear it up then.</p>
<p>This is my reaction to how I might respond to the OP’s experience if it were my kids: when they’re at home, I’m assuming they’ve always told me when they’re going to see a doctor for something, because they want me to pay their co-pay. If our doctor’s office made a comment that one of our kids had been in, and had overlooked a co-pay, my first reaction would be, “Hmmm they didn’t tell me about a doctor visit they had. Something must be up that they don’t want me to know about.” PLEASE don’t take this as my saying it is my right to know this stuff, because as college kids, it’s not anymore, unless they choose to tell me. But I’d rather not know at all about a visit occuring of which they have chosen to withhold from me, instead of knowing they had a visit without telling me, which would probably cause me to worry. I might ask them about it, but then they might lose trust with the doctor’s office for letting this information slip to me, which I wouldn’t want to happen (we’ve all been seeing the same doctor for over 15 years). </p>
<p>However, it is different when the parents are listed as the responsible party and a bill hasn’t been paid. Also, with EOBs, I don’t know how anyone could keep a visit a secret, even if they did make the co-pay.</p>
<p>I guess I’m thinking of times when I was in college and had doctor’s visits of which I didn’t want my parents to know about. If it was at the health center, parents obviously wouldn’t find out unless the child chose to attend. One other visit took place while I was at home over the summer, and because I was afraid of my parents finding out why I was going to a doctor, I went to my city’s public health clinic that was free. I made sure they would not be sending anything in the mail indicating my visit to my parent’s house.</p>
<p>Many offices will not give results over the phone unless the call was initiated by the doctor or his/her nurse. Nosey neighbors have been known to call, posing as the patient, and request test results. </p>
<p>Agree with edad about tests outside the normal range, and, to a certain extent, agree with Northstarmom that you can just “look it up”. Let’s see, hmmm. My lymphocytes are elevated. Well, my allergies have been acting up. No, wait a minute. Could I have an evolving leukemia? Or could it be that I live, statistically, just outside the confidence interval?</p>
<p>Without getting into the the discusion of “small town” v. larger practices, in fact disclosing the existance of unpaid bills is a HIPAA violation unless the patient lists the recipient of the information as the payor or otherwise authorizes disclosure of the billing to the recipient. Billing information, even premiums paid to an insurer and whether they have been paid, are all Protected Health Information under HIPAA. Medical practices always have patients fill out generic forms authorizing disclosure of PHI to obtain payment for services but such authorizations are limited to the designated payor. </p>
<p>In addition, disclosing even generally that immunizations were received, let alone the specific type, is also a HIPAA violation.</p>
<p>Receptionist - O BTW - your daughter has an outstanding bill - just a friendly reminder for you
Dad - O ok - thank you - I will let her know</p>
<p>Not an invasion of privacy - just a friendly reminder</p>
<p>Receptionist - O BTW - your daughter has an outstanding bill - just a friendly reminder for you - it is for innoculations she had before she left for China.
DAD - O OK - thank you - I will let her know - O can I have a copy of it to send to her??</p>
<p>An invasion of privacy - discussing the medical reason for the $$ owed and dad asking for a copy to forward - I guess I would question if the daughter was assumed to be under the parents insurance.</p>
<p>If I were the D, I would be ticked, and would no longer see that doctor. Whether or not my parents knew about my trip, I would feel my privacy was violated, and I’d fear that the doctor’s office would violate my privacy on even more personal things.</p>
<p>Since we can’t ask the doctor’s office and demand to see the paperwork the D filled out, where she CAN list who to release information to, we shouldn’t jump off the handle and shout HIPPA from the highest rooftops. Most practices take HIPPA very seriously and make every effort to comply. More often than not you hear parents complain they can’t get any information and “they are the parents!” because of HIPPA.</p>
<p>Without knowing what your D signed off on or how she set it up, you may simply be thinking the worst first, and what parent doesn’t do that?</p>
<p>The other thing to keep in mind, is by letting you know about an unpaid bill, HIPPA or not, they might be trying to help you D’s credit history. They are doing your D a favor. You and she may not see it that way, but in a few years when she applies for a loan on a home, those unpaid medical bills won’t be staring a loan underwriter in the face in big red letters…</p>
<p>As far as expecting the dr office to wait till she gets back from china to bill? seriously? Doesn’t the dr.'s have staff to pay and bills of his/her own? Isn’t it a bit unfair to assume the dr’s office has cash flow to handle slow to no payors? (reply not to main poster, but another poster who criticised the dr office for billing at all.)</p>
<p>I think the receptionist was probably thinking she was doing you a favor. Also if it is a long time relationship there was probably a time when you did pay her Dr bills. It also could be the receptionist doesn’t have a clue and should not have said anything. I go to a few dr’s offices who have the hardest time getting receptionists who get things right.
What I find interesting with the our insurance company is that our college age children are covered under our plan. We pay the premium and get the EOB statements. But if we have a question about a claim for one of them the insurance company won’t talk to us.</p>