HIPAA’s Privacy Rule | Buying or Changing Health Plans | What Organizations Does HIPAA Apply to?

image There is perhaps no more important health law than the Health Insurance Portability and Accountability Act (HIPAA) of 1996. There are also few more complicated laws, but this article will introduce you to its key components.

In response to the growing amount of electronic health information, HIPAA was enacted in an effort to:

  1. Establish national standards for electronic health information transactions
  2. Secure the privacy of health data

HIPAA also gives you the basic right to buy health insurance and change plans.

And although it was designed in part to simplify matters, healthcare providers continue to struggle to understand and meet the requirements of the act. This gives you—as a healthcare consumer —all the more reason to understand what HIPAA basically means to your care. That way, you can be confident your information is being handled properly, and take action if it is not.

HIPAA’s Privacy Rule

HIPAA is perhaps most well known for its Privacy Rule, which took effect in April 2003. The intent of the Privacy Act is to give people more individual control over the sharing of their personal medical information, while at the same time making it easier for them to access details about their own health and healthcare.

Protecting Your Information From Others

According to the Privacy Rule, healthcare providers must take great pains not to reveal your health information to employers or others who are not entitled to view it. For example, they may not pass on information to companies who are thinking about hiring you, or who want to sell you their latest cures or devices. Also, they may not share any information about mental health consultations.

Such regulations do make it a bit more difficult for family members and caregivers to get information about your health, unless you give them explicit permission, generally in writing. Critics say the regulations could also make it less common for doctors to discuss their patients’ health with them, due to anxiety over infringing on privacy rights. For example, whereas doctors were once willing to discuss lab work on the phone, you are now more likely to get reports in the mail that are clearly marked "personal and confidential." Additionally, doctors’ offices may ask anyone assisting with your healthcare for identification before speaking to them.

However, there are cases when information can be legally shared. Those who are entitled to your health information include:

  • Doctors, hospitals, and insurance companies for purposes of billing and payment
  • Anybody in or out of your family whom you designate to help you with your healthcare, including paying the bills
  • Safety regulators looking into care at nursing homes
  • Public health officials under some circumstances, such as if they were studying the outbreak of a disease in your area, and wanted to know how many cases there were and factors that could be affecting its spread
  • Police when a crime is committed

Granting You Greater Access to Your Own Information

In addition to keeping your health information off limits to prying eyes, the Privacy Act also gives you greater access to this information. Whereas at one time it was often difficult to view your own medical charts and files, you now have the right to know anything pertaining to your health. Under HIPAA, you are legally entitled to

  1. Receive a copy of your health record if you ask for it
  2. Make corrections in the official file

Furthermore, you are entitled to information about whom your records were given to and why.

You also have the right to file a complaint with your healthcare provider, or with the federal Office of Civil Rights, if you think your information has been misused in any way. Call the regional Civil Rights office nearest you for more information. You will be asked to provide the specifics of what happened and the reason for your complaint.

Buying or Changing Health Plans

Prior to the Privacy Rule, HIPAA originally made it possible for virtually everyone to buy health insurance in the first place and to change plans when they change jobs or for other reasons. The regulations provide that:

  • You must be allowed to buy into a healthcare plan no matter what illness you or your covered family members have.
  • If for any reason you lose your healthcare plan, you may enroll in another plan even if it does not allow late enrollees, as long as you apply within 30 days of having lost your previous plan.
  • You have the right to individual healthcare whether or not you are working/employed. When unemployed, however, insurance may be very expensive, especially if you:
    • Are not eligible for the reduced rate plan called COBRA, which is offered to people who lose their jobs for a period of up to 18 months after their previous employer-sponsored plan runs out.
    • Were not covered by another group plan within 63 days of applying for a new one.
    • Did not pay all your bills under your previous coverage.
    • Are not eligible for other plans such as Medicare or Medicaid.
  • When changing insurers, new insurers may not impose limits on pre-existing conditions—illnesses you had before they began covering you—as long as you were covered by some other plan within 63 days of joining the new plan. If you were without insurance for more than 63 days, coverage of pre-existing conditions may not be guaranteed, depending on the length of time you were covered previously. In any event, insurers cannot exclude coverage of those conditions after you have been with them for a year.

In some states, these rules may be more lenient. But, the key point to remember is that if you are ever about to lose your health insurance or find yourself without coverage for virtually any reason, act quickly to be sure you can get coverage elsewhere. For more information, contact your state insurance department.

What Organizations Does HIPAA Apply to?

The HIPAA mandates apply to just about anybody who deals with your healthcare, including:

  • Doctors, dentists
  • Hospitals, clinics, nursing homes
  • Drug and medical equipment providers
  • Third-party medical billing companies and clearinghouses
  • Health insurers, group healthcare plans, HMOs, Medicare, Medicaid, and other government sponsored healthcare programs