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joan29

Ins. Adjuster sharing private health info to sub-contractor without disclosure

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The Insurance adjuster in my Hawaii WC claim has never obtained a disclosure release from me and has shared my health and other private informaiton with sub-contractors or business associates, who also have not obtained a release from me. This has not been about matters  directly connected to determining my rights to benefits. E.g. They shared my information without my prior knowledge or consent with an independent VR counselor, in connection with a squabble they had with my VR counselor about reducing his fees.

 

They used this contractor's services to discredit his work as a means to reduce his fees, which has nothing to do with me.

My question is:- Is the WC carrier considered an entity under the Hipaa rule? if not can they just share my info any time, any way they want for their own ends, without disclosure and release from me?

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 Is the WC carrier considered an entity under the Hipaa rule? if not can they just share my info any time, any way they want for their own ends, without disclosure and release from me?

 

Of course the carrier is an "entity."

 

But you're going a little over the top here.

 

The insurance company did not share your information "any time" "any way they want" "for their own ends."

 

There's a lot of ridiculous hype in those statements.

 

What the insurance did (according to your post) was share your information with ONE other entity, a VR company, for the ONE purpose of verifying your claim.

 

And they don't need notice to you or your consent to do that.

 

Now, I'm not going to sit here and wade through HIPAA but you are free to do your own research on the HIPAA website:

 

http://www.hhs.gov/ocr/privacy/index.html

 

And file a complaint if you want to. It'll probably come to naught but do it if it makes you feel better.

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The workman’s comp carrier does not need your consent under HIPAA for disclosures to business associates or subcontractors. 42 CFR § 162.502(e) states:

 

(1) Standard: Disclosures to business associates. (i) A covered entity may disclose protected health information to a business associate and may allow a business associate to create, receive, maintain, or transmit protected health information on its behalf, if the covered entity obtains satisfactory assurance that the business associate will appropriately safeguard the information. A covered entity is not required to obtain such satisfactory assurances from a business associate that is a subcontractor.

 

(ii) A business associate may disclose protected health information to a business associate that is a subcontractor and may allow the
subcontractor to create, receive, maintain, or transmit protected health information on its behalf, if the business associate obtains satisfactory assurances, in accordance with § 164.504(e)(1)(i), that the subcontractor will appropriately safeguard the information.
 
So the carrier can disclose the information here for the business purpose of settling the fee dispute that it had. I’m not sure why that disclosure has upset you, but in any event it does not appear to violate HIPAA. 

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I didn't say this was the ONLY time this occurred and on THIS occasion it was NOT to verify my claim, this took place a long time ago, if it hadn't I would not be receiving VR. They did it because after making several payments to the VR counselor at his usual rate, they began a squabble with her about wanting to reduce the fees.

 

In the course of this they shared my information which was quoted by their sub-contractor inaccurately, which I had to correct, but they also shared with me a list of complaints about the VR counsellor that undermines our relationship and information about another of her injured worker clients.

 

For the record, 1) they told me the are NOT an entity and 2) I read that although injured workers have no rights under HIPAA except the minimum necessary rule, which I believe has been exceeded.

 

There was no hype and there is nothing ridiculous about a concern for the constant sharing of private information of injured workers, to a lot of different individuals, or to each other, or the sharing of a VR counsellors fees and billing issues with injured workers.

 

Thanks for the link, but I had already reviewed HIPAA rules and did not find an answer, that is the only reason I asked my simple questions here, so there was no need for sarcasm or rudeness. Injured workers are abused enough by adjusters, they don't need it from you.

 

 

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The workman’s comp carrier does not need your consent under HIPAA for disclosures to business associates or subcontractors. 42 CFR § 162.502(e) states:

 

(1) Standard: Disclosures to business associates. (i) A covered entity may disclose protected health information to a business associate and may allow a business associate to create, receive, maintain, or transmit protected health information on its behalf, if the covered entity obtains satisfactory assurance that the business associate will appropriately safeguard the information. A covered entity is not required to obtain such satisfactory assurances from a business associate that is a subcontractor.

 

(ii) A business associate may disclose protected health information to a business associate that is a subcontractor and may allow the
subcontractor to create, receive, maintain, or transmit protected health information on its behalf, if the business associate obtains satisfactory assurances, in accordance with § 164.504(e)(1)(i), that the subcontractor will appropriately safeguard the information.
 
So the carrier can disclose the information here for the business purpose of settling the fee dispute that it had. I’m not sure why that disclosure has upset you, but in any event it does not appear to violate HIPAA. 

 

Thank you for this information. I didn't understand why it was necessary to share my file, or fair for a couple of points in it to be inaccurately quoted, in a report that was only about the VR counselor's practices and fees. This report was copied to me, but not to the VR counselor, which seemed inappropriate to me. The Dpt. of Labor facilitator advised me that signed disclosure releases from me should be filed with them, but there isn't a single one in my file and my information has been shared with so many "entities" or individuals at this point I might as well have my social security number tatooed on my forehead. I appreciate the specific statutes.

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For the record, 1) they told me the are NOT an entity

 

 

 

That's right. They are not a "covered entity" under HIPAA.

 

45 CFR 160.103 - Definitions

Covered entity means:

(1) A health plan.
(2) A health care clearinghouse.
(3) A health care provider who transmits any health information in electronic form in connection with a transaction covered by this subchapter.
 
So HIPAA is irrelevant in your situation and you have no protection under HIPAA at all.
 
However, there are likely other privacy laws that insurance company's follow but, whatever those laws are, they wouldn't prevent the insurance company from providing your information to it's vendors, providers, sources of services or whatever you want to call them.
 
That the results of the sharing of information had unfavorable results to you has NOTHING to do with the insurance company's ability to share the information.

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That's right. They are not a "covered entity" under HIPAA.

 

 

Well, it could be a covered entity depending on the details of the particular insurer, but you are correct that if it is solely a worker's comp (WC) plan it is not a covered entity and HIPAA does not apply to it. There are special rules that apply to covered entities making disclosures to a WC insurer but no HIPAA privacy rule applies to disclosures by a WC plan to others. HHS explains this pretty well here: Disclosures for Worker's Compensation.

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