Okay, maybe the doctor, clinic, or health provider does not call your home. But, every time an insured person receives medical treatment and a claim is made to a medical plan, the primary insured receives a benefit notice detailing treatment and coverage. So, if your child goes to the doctor and an insurance claim is made, the holder of the policy [usually the parent] will receive a notice of benefits detailing the treatment. Same is true with a spouse that is covered under his or her husband’s or wife’s policy.
Under amendments that went into effect January 1, 2015 in California, minors and spouses can now limit what health insurance companies disclose to policy holders. The new amendments were made to the California law referred to as California’s Confidential Health Information Act.
Wait. Doesn’t HIPAA already give patients the right to limit communication of their health information? Yes it does. HIPAA gives patients the right to limit their health communications. And, this right to limit communication extends not only to health care providers, but also to health plans.
So, why the new law in California? The new law in California is seen to close a gap in HIPAA. Under HIPAA regulations.
A health plan must permit individuals to request and must accommodate reasonable requests by individuals to receive communications of protected health information from the health plan by alternative means or at alternative locations, if the individual clearly states that the disclosure of all or part of that information could endanger the individual. 45 C.F.R. 522(b)((ii).
Hence, in order to prevent health plans from disclosing treatment/claim information to a policy holder, the patient must substantiate such disclosure endangers patient. What is endanger? HIPAA does not clarify. It does not explain what endanger means. When thinking of endanger, we think of bodily injury – death.
Not so much. The new California has a looser definition. Under amendments to the California’s Confidential Health Information Act, endanger means “fears that disclosure of his or her medical information could subject the [individual] to harassment or abuse,” Cal. Civ. Code § 56.05. Notice the word fear. Actual knowledge is not required. And, bodily harm or death is not required. Simple harassment will do.
In a previous blog we discussed disclosure to family members. What are your thoughts? Is California on to something here? When evaluating patients’ requests for restriction and disclosure what does the endanger standard require? HIPAA law is silent. If you are in Ohio, a patient must make a request to restrict disclosure to its health plan. Is it sufficient if the patient claims their parent or spouse will harass them if the information is disclosed?