>>> "Deborah Campbell" <[EMAIL PROTECTED]> 01/28/03 01:36PM >>>
Deborah Campbell
Compliance Coordinator
Dominion Dental Services,
Inc.
115 South Union
Street, Suite 300
Alexandria, Virginia 22314
Phn: (703) 518-5000 ext.
3035
Fax: (703)
518-8849
Toll
Free: 888-518-5338
Email: [EMAIL PROTECTED]
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> --------Original Message-----
From: Jim Moores [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, January 28, 2003 10:06 AM
To: WEDI SNIP Privacy Workgroup List
Subject: Some Questions that I've asked before....Hi All,I've asked these questions before, but didn't get much response (or any at all on some). Since we're all getting close to THE DATE, I thought re-asking might get more/better response, so I'm re-posting a digest of the questions. Any discussions of what you are doing and / or suggestions are welcome....._____ Private Communications ____________________________________________---These questions are about Private Communications (PC) & Customer Service:1) How do you respond to a Customer Service Inquiry from the contract holder (subscriber) when someone on that contract has invoked PC? Do you just say, "I can't give any further information" or "I've released all the information to which you are entitled" or .... some other sentence/phrase with similar meaning? I realize you can't just say, "Someone on your contract has requested Private Communications".Possible scenario: Jane, the wife of Joe Contractholder requests PC, primarily because she's going to a psychologist. Because Jane has requested PC, the insurance company (or provider) routes ALL her claim EOBs (or bills) to an alternate address. Joe calls customer service to ask where the Explanation of Benefits (EOB) is for his wife's recent visit to the Emergency Room for a twisted ankle. How should the customer service rep answer....?2) How do you send out the EOB when you have a non-custodial and custodial parent getting EOBs and one of the children has invoked PC? We have a number of these situations where we have received a Domestic Relations Court Order to send the underage dependent EOBs to both the custodial and non-custodial parents. As long as they haven't reached 18, we comply with the order (or if a dependent is in college, until they graduate).Possible scenario: Joe Doe (Contractholder) and Jane Doe (Joe's former wife and mother of Donna Doe) have both been receiving Donna's EOBs pursuant to a court order. Donna's in college and goes to her OB/Gyn and asks for birth control pills. Donna doesn't want her father to know (he has a temper), so she invokes PC with both the Provider and the insurance company. All of a sudden, neither Joe or Jane are getting copies of Donna's EOB's. Jane knows that Donna went to the OB/Gyn but doesn't get a copy of the EOB. She calls Joe and asks if he has gotten the EOB yet... of course he says no. So she calls customer service. How should the customer service rep answer? Does HIPAA Privacy override the Domestic Relations Order or vice versa?3) How do you respond to a 12 year old who asks for PC when calling/writing to Customer Service? Do you explain and direct her to go to court to get a court order giving her the right to invoke PC? Do you grant the request absent the court order even though she isn't 18 (or what ever the age of majority/emancipation is in the your state)?We are primarily concerned with inadvertently cluing in a parent/spouse that there has been a PC request, where the contractholder thinks that they have the right to get such information (people can get pretty irate in these situations). We want to avoid the situation where an abusive spouse/parent figures something funny is going on, and injures the person who requested PC in trying to get them to tell the abusive person what's going on. What are our responsibilities when an underage dependent asks for PC?There doesn't seem to be any good answers here, only compromises that have varying degrees of risk. How are you people out there planning on handling these situations? Any help / advice / suggestions would be welcome._____ Amendments ____________________________________________Say that you do turn down an amendment request (for good and legitimate reasons... ie amending medical data that came from somewhere else). The regulation says that (after going to an appeal process) the patient/member has the right to file a statement giving their side of the story and make it a part of the record or just have it noted in the record that an amendment request was filed. The CE that receives the request/statement must then include that an amendment was filed and (if supplied) the statement in all disclosures of that claim data from that point forward... and have it sent to specified entities that have already received the data. There is even a point in the reg where it says that the amendment flag and statement must be sent along with a standard transaction, even though there is no place for it._____ How detailed must my Designated Record Set be?________________________Should the DRS be at the level of the EOB or should you give the most of the data elements in all patient/subscriber related systems? The Regulations clearly state that we must show all data that we used to make a decision about the subscriber / patient.... But at what level?I vote for somewhere in between. Clearly, as an insurance company, we don't have to disclose confidential corporate data (like how much the discount %/$ are for any given procedure for that provider or our rating formulae).All opinions expressed are my own and should not be construed to be Medical Mutual or Antares Management Solutions official policy.Jim Moores - HIPAA Team Leader - Privacy
Antares Management Solutions
23700 Commerce Park Road
Beachwood, Ohio 44122-5832
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CONFIDENTIALITY NOTICE: This message is intended only for the
use of the individual or entity to which it is addressed and may contain
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under applicable law. If the reader of this message is not the intended
recipient or the employee or agent responsible for delivering the message
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prohibited from printing, storing, disseminating, distributing or copying
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from your computer. Thank You, Antares Management Solutions.
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