Insurance requires my mother to be present?

[Jensa]

Since laws can vary by state, I'm in Georgia.

I have a pre-op Friday, and do not want my mother in there with me. She claims her insurance needs her to be in there. Are there any insurance providers that require this?

[Jensa]

Whoops, sorry. Forgot to add that I'm a legal adult but still under her insurance.

[cbg]

I don't know of any offhand but that doesn't mean none exist.

Have you asked her to show you where in the insurance policy it says she has to be present?

[Jensa]

Originally Posted by cbg

I don't know of any offhand but that doesn't mean none exist.

Have you asked her to show you where in the insurance policy it says she has to be present?

No, but I will tomorrow. If she can't I'll call the insurance company just to double-check. I posted here because it's too late to call them.

[cbg]

This is going to be a matter of contract, not of law. The law does not require that she be present. The insurance contract MIGHT (though I doubt it).

[purple2]

OP, I'm wondering if you were misled. It's more likely that the hospital requires you to have someone accompany you home for safety purposes rather than to discharge you in a taxi alone.

[cbg]

Purple, VERY good suggestion!

[purple2]

In my area hospitals will not discharge someone unless they are accompanied by a caretaker. It does not need to be a specific person. It is not just that they need a ride home but they require someone to agree to be with the patient for at least the whole day she is discharged.

I believe an insurer could legally require someone to be in the room as a condition of payment, as I'm not aware of any law prohibiting it. The patient is free to refuse, as is her legal right, but that doesn't mean the insurer is required to pay the bill. This is all theoretical though; I seriously doubt the insurer in this scenario is really requiring this.

[cbg]

HIPAA is not nearly as broad as most people seem to think. The privacy element in HIPAA relates to electronically transmitted records.

[cbg]

No, that's not correct, but I'm not about to argue the issue with you since it's clear your mind is already made up.

If the patient consents, either willingly or by "attrition" as it were, to having someone else present during the procedure, there is no protected information involved.

[cbg]

I am aware that insurance companies are covered entities under HIPAA. I have taken HIPAA training classes and have worked with HIPAA in other areas.

The chances that the insurance carrier is actually requiring this is slim indeed. If you read the entire thread carefully, you will see that no one who has responded actually believes the insurance carrier is making this requirement. The general consensus is that (a) the mother is making it up so that she can be present (b) the hospital (NOT the insurance carrier) is making a requirement that someone be there to drive the patient home, but not necessarily be present for the procedure or (c) either the mother or the poster has completely misunderstood the request. Or a combination thereof.

If the insurance company is not requiring the patient to consent to this, and no evidence has been presented to say that they are, HIPAA becomes moot.

[purple2]

Originally Posted by cbg

No, that's not correct, but I'm not about to argue the issue with you since it's clear your mind is already made up.

What he said.

[cbg]

P.S. I'm a she. ( )

[ablessin]

Originally Posted by cbg

HIPAA is not nearly as broad as most people seem to think. The privacy element in HIPAA relates to electronically transmitted records.

HIPAA is not soley related to electronic communications. As a large hospital employee, we are reminded all the time,,**************.

1. Not to talk about patients inthe hallway, on the elevator, etc...
2. We can't copy medical records for just anyone and send them
3. We can't fax medical records, unless it's to another hospital department
4. We can't look up family and friends medical information
5. When sending an insurance carrier records, it can only be specific to that service in question.

And on and on the list goes..... But it is verbal and paper as well as electronic protection.
Heck, someone who kept PHI on a laptop that was stollen got into trouble because the laptop was not password protected and that health info was potentially open for public viewing!!!!!!!

That being said, I highly doubt that the insurance is requiring anyone to be present. I agree the facility may want someone present to transport the patient after the procedure, especially if anesthesia is to be used. Many providers won't begin the procedure until the driver is present and agrees to stay.

The only way to be certain, would be to call the insurance carrier and flat out ask if someone is required to be present for the procedure, and if so, does it have to be the policy holder.

[purple2]

Originally Posted by cbg

P.S. I'm a she. ( )

Sorry! I always thought you were a he!!!