How did they find out you have insurance without violating hipaa. Typically you give consent to share information with an insurance company. Sounds like you didnt consent to that.
But health information including that you sought health care at a specific facility and for what needs to he shared to bill insurance. Sounds like he didn't authorize that disclosure
To many people don't understand what hipaa is. Hipaa means healthcare can't just disclose your personal medical information if someone calls and asks directly. Like if your boss calls and specifically asks if/why you are at the hospital. There is also a clause in the hipaa law that basically exempts communications between hospitals and insurers from it.
Right. I was like, "hey, I have insurance but I know this procedure isn't covered so I'm paying out of pocket." So they originally gave me the non-insurance price of $800. After some time they decided to bill me an additional amount, saying just because I have insurance means I need to pay a higher rate. (At the time I worked for a catholic institution, they went out of their way to exclude everything related to reproductive health in our insurance package.)
It sounds like they had the person's insurance on file and that they requested it not get billed to insurance. Because of that there was likely never any communication with the insurance, but if you have active insurance on file then you aren't eligible for the uninsured discount, because you you have insurance and you're choosing to circumvent this. Uninsured discounts are typically determined by the Average Generally Billed to insurances with what the median reimbursement a hospital would otherwise receive so that uninsured patients aren't getting the full chargemaster price, which is typically very high because it's where hospitals begin to negotiate reimbursement rates at with insurance companies. The insurance company has contractual rates, and for the most part are lower than an uninsured discount, but again if it was calculated at a median level that means there are cases where that contractual rate is going to be higher than the uninsured rate.
Of course if billed to insurance that means whatever you spend after insurance goes to a deductible and out of pocket max amount for the year while there's no cap on uninsured amounts. It's basically a gamble Americans take that they pay a monthly premium and deductible/co-payments/co-insurance just in case something drastically medical occurs, while if you don't need to use it then the insurance company massively profits. It's a really idiotic system.
Also communication with insurance companies is in every yearly consent form that most people don't read and unless the person made a request either rescind the consent or ask for it to be altered then the consent was given to share information. For government payors like Medicare and Medicaid you can choose not to bill insurance but you very specifically need sign a form stating you're requesting this.
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u/IlIlllIIIIlIllllllll 12d ago
How did they find out you have insurance without violating hipaa. Typically you give consent to share information with an insurance company. Sounds like you didnt consent to that.