<p>Physician practices and laboratories have spent a ton of money on HIPPA-“compliant” information systems, billing and record systems, and document disposal services. Many, however, seem to neglect office staff training.</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 wasn’t criticizing the doctor’s office for billing. I was pointing out to the person who suggested that the doctor’s office was talking to the parents to avoid using a collection agency to get the bill, something that would have reflected badly on the D’s credit.</p>
<p>Clearly, the doctor’s office knew that the patient was going to China. Consequently, the doctor’s office could have checked while the D was right there in the waiting room to find out whether the insurance would cover that bill. </p>
<p>The doctor’s office also could have sent another bill to the D’s address on file, and have assumed that the D had made arrangements to have her mail forwarded to China. They even could have written on the envelope: “Important” so as to catch the D’s attention. </p>
<p>Or if this was a longtime patient from a family that has always been responsible with bills, as it appears is the case, instead of the doctor’s considering using a collection agency – which would have cost the doctor’s office money – the office could have billed the D after she returned from China. I doubt if the doctor’s office would have run into financial difficulties due to waiting several months to collect on a $200 or so unpaid bill from a longtime patient. (Incidentally, my dad was a dentist in a small, poor community). </p>
<p>My point is that IMO there was no excuse for the doctor’s office telling the D’s parents about her bill. That violated privacy and was inexcusable. And if the D chooses not to pay her bills, that’s her problem, not her parents. For all we know, she got the bill that her mom forwarded, but chose to ignore it, which is a mistake, but still is her business.</p>
<p>Amen, Northstar. When I first became a physician the “rules” were so different. It would be so wonderful to not have to worry about privacy laws but it is also nice to have them… Sure wish physicians could just do what we’re trained for/good at- practicing medicine. </p>
<p>Changing physicians based on office staff… pros and cons. Sometimes put up with some things because … also hard to have to start over… new office may be no better… Where are Marcus Welby and all those idealized physicians? Today they would be in prison for many breaches…</p>
<p>Like all issues- more than one side, good/better/best ways of handling things. I have my own list of complaints and frustrations, and I’m a physician patient!</p>
<p>OP,
Something similar happened to my dad when his mother died. He got a bill from a medical doctor. She was totally independent of my dad- living on her own, paying her own bills, etc. He called the office up and told him it wasn’t his bill. They thought he was going to pay it, just because I guess.<br>
Pretty bizarre.</p>
<p>“My point is that IMO there was no excuse for the doctor’s office telling the D’s parents about her bill.”</p>
<p>except none of us know including the poster, if the D signed off that it was OK to talk with listed family memebers…also part of hippa… </p>
<p>Not trying to start a fight here, but it isn’t cut and dried. It’s a libarian comparing libarary policy vs. a doctor’s office. Apples and oranges. And we will never know because of privacy laws… what the daughter agreed to. </p>
<p>I am basing my feedback on the paperwork I fill out every year at my various medical providers offices which simply asks me to list whom I want my information provided to. I put my wife, my mom and my kids on there. They all do the same. Would it be out of line for my D’s medical provider to inform me? no, not in this case because my D has authorized it. </p>
<p>In some ways too this is a complaint directed at the wrong person. If DD had paid her bill on time, is there any need to mention it? </p>
<p>“I’m mad at you because my kid didn’t pay her bill and it’s overdue… and that’s your fault for telling me?” These days it is far easier in finding fault in the messenger than the responsible party.</p>
<p>While I haven’t talked to my daughter, I can tell you with 99% certainty that she would NOT sign off to have any information released to any of us. She’s a very private person. I know that when I go to a doctors office I do not sign off for anyone else (including my husband) to have access to that information. When we were trying to figure out what would be covered before she went overseas a year earlier I called our insurance company and they would not tell me anything regarding any of her prior doctor visits. We talked hypothetically about what might work. (Thank goodness that she never reads CC!)</p>
<p>As I mentioned before, my daughter is not a college student, she’s almost 23. Her insurance, including the card, is from a different provider then ours.</p>
<p>Opie, would you like your mother to get a bill from your doctor with the print out that includes what was done? As long as you are assuming, why don’t we assume that my daughter paid this bill from China and didn’t tell me about it? I certainly don’t tell my mother what bills I pay every month. </p>
<p>As far as the library goes, my point was that if at our little local library we’re not telling a parent that their 16 year old son has a $50 fine, how can a doctor’s office give a bill to a parent of a 23 year old? </p>
<p>I am “mad” at the Doctors office for bypassing my daughters confidentiality. The amount is not that much, and the receptionist actually told my husband to just wait to pay it because the person that did the money was on the other phone.</p>
<p>
Sigh… if it were only that easy. Typical scenario: (1) call insurance company customer service #, push a bunch of buttons and get transferred several times (2) sit on hold for 25’ , and if you don’t accidentally get disconnected and have to start all over again you (3) speak to a customer service rep who tries to clarify if the call is to check member benefits or to follow up on a claim (they’ll try to transfer you to claims if you mention something about cost/payment) (4) the customer service rep will quote general benefits but cannot confirm if a certain lab or CPT code is covered and will not tell the Drs office if the patient’s deductible has been met (this happens with about half the insurance companies). The rep quotes general benefits (ie $300 deductible, 20% coinsurance) but ends with the caveat “verification of benefits is not a guarantee of payment. Payment decisions are made at the time a claim is processed”. And, try multiplying this procedure by 10 or more, if you had to check benefits on many of the patients being seen that day. It is simply unwieldy.</p>
<p>So no, it is not as simple as simply “calling the insu co to see if an immunization is covered”. Often a Drs office will file the claim, especially if they don’t know what the allowable is, and then bill the patient for the balance due. </p>
<p>Kathiep-
While I understand your general question, especially from the perspective of your overly careful library system, I kinda think some posters here are making a mountain out of a molehill. Sunnyflorida is correct-- the fact that someone was seen at a Drs. office is not considered private (or is it protected?? I forget) medical information (PMI) under HIPAA, but the contents of the records are.</p>
<p>“Opie, would you like your mother to get a bill from your doctor with the print out that includes what was done? As long as you are assuming, why don’t we assume that my daughter paid this bill from China and didn’t tell me about it? I certainly don’t tell my mother what bills I pay every month”</p>
<p>OK let’s play which is a worse senario…</p>
<p>A kid I used to coach soccer (a young adult) was traveling in Ore. a couple years back and had an epilectic episode (first time) fell and cracked his head open. He was rushed to the hospital. Friends called mom, up here in WA. She called the hospital where admitted, they could not tell her anything because of hippa rules. She could not find out if her son’s head injury was life threatening, life altering or just a bump. A five hour drive to the hospital not knowing how bad your kid (and your d at 23 is still your “kid”) is sucks pretty bad… </p>
<p>My mom getting a bill showing a wart removed from my backside??? not so bad… “yea, mom and I named it too… his name was Burt.”</p>
<p>There are many things to be outraged in life about, this ain’t one of them. And 99.9% sure isn’t 100%. Maybe in light of how hippa works, you might reconsider being too private. </p>
<p>My mom used to change my diaper (week before last), I doubt an eob would throw her off that much.</p>
<p>“I am “mad” at the Doctors office for bypassing my daughters confidentiality”</p>
<p>Let me ask this would you be madder at them for submitting her to collections at 23? if down the road it cost her a home because of bad credit?</p>
<p>Would you then be complaining “if only they told us, we could have paid the $35 charge while she was gone. They didn’t have to send her to a collections office. It was such a small amount.”</p>
<p>In WA, patient billings come with the threat of collections written right on them BEFORE insurance has a chance to pay. I have helped people sent to collections where the doctor’s office never billed insurance. As I see it, they were really doing your daugther a favor. Had that been a corporate practice, and she hadn’t paid, it might already have gone to collections once it was in the system. Automation… </p>
<p>I guess you can be mad about they handled it, but really if they decided to go the tradition collections route… which would have hurt your daugther more?</p>
<p>Opie, you are so good at twisting things into scenario’s that fit your point. What if the bill had a pregnancy test on it? C’mon…</p>
<p>I am not outraged. I’m simply a parent venting on the parents board. I actually said in an earlier post that I understood the reason they told my husband and was glad that we (or she) can pay it before it goes to collection.</p>
<p>Ok-- mark this day on your calendar… I am inclined to agree with Opie! Or, at least I get where he is coming from.</p>
<p>While I am not saying it was ok to ask dad about daughter’s bill, I also think it is not a situation that calls for someone to be indignant. It is unreasonable to expect a doctors office to float someone a free loan for several months. Again, multiply that by hundreds of patients, deal simultaneously with insurance denials, ridiculously low reimbursements and other bad debt write-offs and it DOES affect the cashflow of an office. Besides, it is also possible that if the daughter didn’t live at home before going to China, that her bills were returned to the Drs. office (mail is only forwarded for up to 6 mos now, and besides, I doubt that the P.O. will forward domestic mail to China without additional postage) and perhaps the Drs. office didn’t have any other way to reach her. Please don’t let this become another doctor-bashing thread.</p>
<p>JYM - well put - we ALL make some mistakes in our lives - big ones and little ones - give the receptionist just a bit of breathing space here - it was not intended as harmful or arrogant in any way - more of an attempt to be helpful. I would take it as just that - and in some ways be thankful that the bill will be taken care of accordingly.</p>
<p>Food for thought…
Receptionist: “Mr. X, has your daughter returned from China yet?”
Dad: “No, why”?
Receptionist: Do you have a current address or way that we can contact her?
Dad: Is anything wrong?
Receptionist: “If you speak to her, can you ask her to get in touch with us?”
Dad: “Sure. Is everything ok?”
Receptioninst: “I am sorry, I am not permitted to disclose any PHI”
Dad: Should I be worried? Is everything ok??"
Receptionist: “I am sorry, I am not permitted to release any information”.</p>
<p>Wouldn’t you, as a parent, be a bit concerned? The receptionist would be more closely following protocol (though certainly one could argue that even asking for a way to contact a family member might be a violation of HIPAA) but lets be reasonable. I am also going on the assumption that this is a small private practice Drs office and not a big group practice or clinic. The bigger the facility, the less likely it is that any receptionist is going to know the individual patients, remember their travel plans, etc. Also, bigger groups usually use billing companies, and batch bills are computer generated. Not likely someone is going to look for an individual bill or claim and write “important” on the envelope, as one poster above suggested.</p>
<p>The issue really is the expectation of privacy and HIPAA codifies that expectation under a very stringent set of requirements. What makes it difficult, however, is that HIPAA and its enabling regulations are extremely complicated and in many respects are inconsistent with common experience and often common sense practicalities. The parent who pays for the health insurance for their 18 year old college student but can’t find out from the insurance company if the premium check has been received unless the student signed a waiver, the spouse who can’t call the Dr’s office and inquire about the overdue test results for a working spouse who can’t make the call from work, the list is long and often ridiculously frustrating. (Contrary to what was posted earlier, it even includes disclosure that an individual is a patient or was seen at a Dr’s office on a particular day!) But there is good reason for this legislation driven by the need to protect privacy in a world that relies increasingly on information sharing across electronic networks and other means that are impersonal and often inattentive to legitimate privacy concerns. It properly reflects a concern for preserving zones of privacy in a world that is increasingly intrusive. And the risks of sanctions for covered entities that violate the regs are substantial. Not only can individuals file complaints with the Department of Health and Human Services but, in addition, more resources are being allocated to the HHS to conduct compliance audits of covered entities both with respect to HIPAA’s privacy regs and the newer electronic security regs. (And if you think the privacy regs are a quagmire, the electronic security regs that are part of HIPAA were designed by a certifiably insane person.)</p>
<p><a href=“And%20if%20you%20think%20the%20privacy%20regs%20are%20a%20quagmire,%20the%20electronic%20security%20regs%20that%20are%20part%20of%20HIPAA%20were%20designed%20by%20a%20certifiably%20insane%20person.”>quote</a>
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</p>
<p>I will definitely second that!!! (person with good working knowledge of it - absolutely insane person developed it!)</p>
<p>MichaelNKat-
You sound like a HIPAA compliance officer. Very knowledgeable about this stuff. [WARNING: I am about to talk politics briefly-- anyone who does not want to read about politics – skip to the end of the post] </p>
<p>MichaelNKat- correct me if I am wrong, but if memory serves me, HIPAA was started during the Clinton administration when efforts were beginning to be made to make healthcare information more available-- eg, if you were travelling out of state and had a medical emergency, a doctor or hospital could easily access your medical history. The intent is a good one-- makes sense. Theere were previous plans to encript such information in the magnetic strip on the back of a person’s insurance card, so that when you presented it to a Drs office they could “read” it and get your history. Good way to try to use modern technology for medical management. But certainly they had to try to protect privacy. So, OK, the beginnings of the HIPAA laws began during Clinton. Then, in came the Bush administration. If I remember correctly, there was a lot of political cajoling going on. Rumor had it the HIPAA legislation was purposely bogged down with a ton of encumbering mumbo jumbo, making it long, hard to read, and, in its form, likely (or rather hopefully-- that was the intent) to be defeated in the legislature. But OOPS-- it passed!! So we were blessed with this very lengthy, hard to decipher system. And then, a few years later, as MichaelNKat explained, we were blessed with additional, even more cumbersome electronic security rules. </p>
<p>In truth, our medical information is readily available. The MIB (Medical Information Bureau) keeps a large database on us that is accessed by insurance companies, and probably other entities. So, as hard as we try to protect our healthcare information at one end, there is a gaping hole in the other… MichaelNKat, can you enlighten us more about this?</p>
<p>Here’s information about the Medical Information Bureau if you want to be worried about the privacy of your healthcare or credit information [Medical</a> Information Bureau - Wikipedia, the free encyclopedia](<a href=“http://en.wikipedia.org/wiki/Medical_Information_Bureau]Medical”>MIB Group - Wikipedia). Its a big giant database in the sky…</p>
<p>… by the way Jeepmom, thanks for your kind words!</p>
<p>This is how easy it is to slip up under HIPAA guidelines… this is a true conversation that took place with another classmate when I was still finishing up my masters:</p>
<p>classmate: where do you work?
teriwtt: I work for _____ hospice agency?</p>
<p>classmate: really? I’ve always been interested in doing pastoral care work; what’s a typical day like for you?
teriwtt: it depends, some days have lots of driving in between seeing patients, and some days I have five patients to see in one nursing home. But it’s generally a lot of driving regardless.</p>
<p>classmate: are nursing homes really depressing to visit?
teriwtt: I’ve learned not to judge a book by its cover; some facilities are beautiful, but neglectfully understaffed, while other facilities look like nothing’s been done to them since the 60s, but their staff is the most attentive I’ve seen. Like one of the nursing homes in ____<strong><em>… you’d think being in the wealthy community of _</em></strong>, where residents pay an arm and a leg to live there, care would be very attentive, efficient and caring. But I’ve heard of some families who have not been happy with their loved ones there.</p>
<p>classmate: oh, you go to _______ nursing home? _______ is where I live.
teriwtt: yea, I currently have two patients there I follow.</p>
<p>classmate: I know someone there now who’s under hospice care. What’s the name of your agency again?
teriwtt: (trying to back pedal but now realizing I’ve spilled too much). I work for ________ agency.</p>
<p>classmate: that’s the one this person is with.
teriwtt (to myself): boy I screwed that one up.</p>
<p>Lesson to self - while you may have the best of intentions when entering into a conversation with someone, you can never predict where it’s going to lead, and how the other person might be able to piece two and two together and gain information that they shouldn’t be privy to… such as this classmate now knowing that I was this person’s chaplain. That was not my call to make, and while I wasn’t too worried about any repercussions, I did unintentionally violate HIPAA. So I’ve learned to be very careful about what I say to who about my work. Now, if I’d run into this classmate at the nursing home by coincidence, and she saw who I was visiting with, I obviously couldn’t deny the association as I wear a name badge when I’m working. Even when we sign in the visitor’s logs at nursing homes, we list our names and the company we’re with, but where it asks for the name of the resident we’re visiting, we just put _____ Hospice Agency patient. That way, the people who visit other residents after us, can’t look at the visitor’s log and determine that certain residents are on hospice services just from our signing in.</p>
<p>It’s soooo complicated, and like me, the receptionist at the OP’s doctor’s office may have slipped momentarily, not realizing the girl was as old as she is, or that her insurance was different than her parents. It doesn’t excuse the fact that she might have violated HIPAA if the OP’s daughter does not have a signed waiver in her chart to release that kind of information, but I can see how easy it is to slip.</p>
<p>If it were me, I might call the office manager and run the situation passed them, without expecting any explanation from them. If the receptionist was at fault, then she needs to be made aware of it, but no more information about the OP’s daughter should be released, pending her approval.</p>
<p>Below is the link to the ACLU’s interpretaion of the Privacy Laws, with 2 specific parts reprinted. Hospitals often are way too restrictive and misunderstand HIPAA when relatives request information in emergency situations, and do have the discretion to do what is in the best interest of the patient. The original situation with an overdue bill for immunizations was an example of a receptionist trying to be helpful. I doubt that this complaint would go anywhere. I think that office staff often use discretion and if it were a bill for an abortion it is likely she would not have asked the parents about paying it, as mentioning the overdue abortion bill to them would generally be not helpful to the patient. </p>
<p>[American</a> Civil Liberties Union : FAQ On Access to Patient Information by Friends and Family](<a href=“FAQ On Access to Patient Information by Friends and Family | American Civil Liberties Union”>FAQ On Access to Patient Information by Friends and Family | American Civil Liberties Union)</p>
<p>Q: What other kinds of information can a hospital disclose about my loved one?</p>
<p>A: The Privacy Rule allows hospitals and other medical facilities to continue their traditional practice of compiling patient directories and releasing that information to the public, unless the patient objects. Specifically, the Privacy Rule permits these organizations to compile and release: (1) patients’ names, (2) their locations in their respective facilities (e.g. room number), and (3) statements of patients’ conditions in general terms.[iv] </p>
<p>Furthermore, the HIPAA Privacy Rule allows health care providers to give family members, close personal friends, or any person who the patient identifies, information relevant to that patient’s medical care, such as that person’s condition after surgery.[v] </p>
<p>Q: What kinds of information can I learn from a hospital when my loved one was unconscious when admitted? </p>
<p>A: Under the Privacy Rule, a hospital or other health care provider ““must inform the individual and provide an opportunity to object to uses or disclosures for directory purposes ? when it becomes practicable to do so.””[vi] However, in emergency circumstances (such as when an unconscious person is admitted), a hospital or other health care provider may use or disclose the patient’s directory information if (1) to its knowledge, the use or disclosure is consistent with any preference the patient had expressed in the past, and (2) the hospital or health care provider determines that it is in the patient’s best interest to use or disclose his or her information, in the exercise of its professional judgment.[vii]</p>
<p>By the way, teritwitt, I don’t think that disclosing where you work, such at a hospice through an agency, violates privacy, unless you as a nurse or aide specifically gave information out about the patient in a nonprofessional setting. For instance if you revealed protected information such as diagnosis. But why would just saying where you work and for which agency violate HIPAA?</p>