Your Rights Under HIPAA

By: Dr. Eddye Bullock, M.D.

Chances are that during one of your visits to your doctor’s or dentist’s office, one of those numerous forms attached to the clipboard was a form regarding HIPAA that you had to sign. What is HIPAA you may ask? Is it some new exotic contagious disease? Not quite. HIPAA or the Health Information Portability and Accountability Act was enacted by Congress in 1996. HIPAA was designed to protect patients and consumers. There are multiple parts to HIPAA.

Part I

The first part of HIPAA limits the restrictions that an insurance provider can place on pre-existing conditions when you change insurance companies. A pre-existing condition is any medical diagnosis that was given to you prior to applying for insurance. Say for example, you were diagnosed with high blood pressure 2 years ago and have been on medications. Now, you get a new job and have to change your insurance company. The high blood pressure is considered a pre-existing condition. As a result of HIPAA, your new insurance company can limit your benefits regarding any treatment for the high blood pressure from 0-18 months. Prior to HIPAA, the new insurance company could deny coverage all together.

Part II

The second part of HIPAA regards who can have access to your health information. PHI or protected health information is any part of your medical chart and payment history. This is the reason for signing the form when you make that initial visit to any health care provider. Your doctor can not disclose to anyone your diagnosis, medications, insurance information, or even that you are a patient in that practice or hospital without your permission.

Exceptions

As with any rule, there are some exceptions. The physician can disclose information to your insurance company to get payment for services. Also, if you physician refers you to another specialist, the physicians can share your health information to help facilitate your medical care. Also, physicians and hospitals also may disclose PHI when required by law (a subpoena) or cases of child or elder abuse. Due to HIPAA, your boss or your nosey Aunt Rose cannot call your physician and get medical information without your written consent. Likewise, a spouse or concerned child of an elderly parent can not call the physician’s office on behalf the patient and discuss medical care without written consent. This is regardless of whether they have a legitimate reason for the call. If a physician violates the HIPAA provision he or she can be subject to hefty fines and sanctions. So, understand that your physician is not trying to give you the run around or make you jump through hoops, but unless there is a signed release in the chart to disclose health information with someone else other than the patient, the physician cannot legally entertain the discussion.

Medical Records

Lastly, HIPAA allows you, the patient, to have access to your medical records. You can request a copy of your chart. Be mindful, physicians can still charge you for this copy since they own the record. You have the right to request a correction be made to your record. It is up to the physician to decide whether a correction is applicable. Your medical record is a legal document so some things that may be documented, but that you disagree with may not be able to be removed.

If you feel that your PHI has been wrongfully disclosed, you can submit a complaint to the Department of Health and Human Services Office of Civil Rights.