I just got diagnosed with a chronic illness and suddenly I’m getting letters from my health plan about it. I realize they get the bill for my office visit but what else are they getting? And who said they could have it?
Dear Privacy Disturbed,
Getting a new diagnosis is jarring enough. And then to be surprised by other people knowing about it was probably unpleasant.
When you “signed out” at your doctor’s office, you signed a form allowing the doctor to bill your insurer. On the bill, your diagnosis is listed. The diagnosis is actually required to be on the bill, for the plan to pay. That is why they knew about your illness.
Whenever your doctor’s office gives information to another person – a specialist, your health plan, a hospital – your permission is needed. The Health Insurance Portability and Accountability Act (HIPAA) put many privacy rules into place. Different doctors’ offices have different approaches to handling this, but all will have legal forms for you to sign. If you were a child or had a legal guardian, the parent or guardian would sign on your behalf.
Your health plan gets only enough information to do their tasks – pay the bill, run disease management programs, and oversee quality of care. They won’t get lab test results or details of any discussions you have with your doctor. And any information your plan does get, they have to use for operating the plan; they cannot share it with others without your permission.