Collection Agents and Private Health Information

[magzi]

What is the name of your state?
NJ
Can a medical provider release medical information to a collection agent. If so under what conditions/circumstances? I don't believe a collection agent needs this information to collect on a bill. Nor do I see where the individual's privacy is protected here.

 

[shadow01]

You bring up a good point, one of which I never thought about.

I had an amniocentesis done and some ultrasounds and the hospital doing it had me under the wrong insurance plan in which I was being balance billed when I should not have been. It ended up going to collections and I just recently found a printout from that collection agency stating exactly what I had performed and on what dates. Isn't that private stuff?

I'm interested in the answer to this myself.

 

[magzi]

I also sent an e-mail to a collection agent advertising their services. I told them I was new to the medical profession and asked what information they needed to collect a medical bill on my behalf. The actual medical information was not on their list. Simply the debtor's name, address and telephone number and obviously the date of service and amount owed. Hmmm! I sure hope someone qualified has the answer to this. Thanks for your input.

 

[Ladynred]

This all falls under HIPAA and protected health information (PHI).

When a medical provider sends your account for collections, that provider MUST have an Business Associate agreeement with the collection agency in order to release ANY information to them. If there is no agreement, then they face some serious charges for violating HIPAA regs. The CA, to a limited degree, can release PHI, but ONLY to that person and no one else.

 

[magzi]

HIPAA is not very specific in this area. Collection agents are not billing agents. They do not need medical records to legally collect on the debt. By the same token, if your credit card balance is turned over to a collection agent are they provided with a list of everything you purchased? No, of course not. It would seem to me that credit card purchases aare a bit less sacred than medical records. A business affilliate agreement does not specifically entitle a collection agent to have medical records in their possession. ( Unless I have not read the law correctly. If you can pint out where it doe please let me know). I asked the ambulance company for a copy of their agreement. The AR clerk referred me to the AR manager who never returned my call. The clerk asked me "just where are you going with this?" Believe it or not.

 

[Ladynred]

Well, let me check with our HIPAA compliance officer at work - I work for a healthcare company. I'll post back any info I get.

 

[bigun]

Good morning LIR!

I've been meaning to ask you this so I'll apolgize for hijacking the OP's thread but it's kinda on point.
We've seen Why Chat's Hipaa letter work the majority of the time on creditboards. There are a couple of new testimonials on there this morning. DO you think there is so much confusion about Hippa and privacy rights that healthcare professionals would just rather get paid and not deal with stuff like credit reporting and responding to Hippa violations? It all looks like a massive bluff but damned if it doesn't seem to work and work well!

 

[magzi]

I'm not following your your reply. Is there a site or chat room out there that I should go to for some information. What to you mean by bluff. Can you please be more specific. Thanks.

 

[bigun]

Here are 2 sites. The first is run by a retired consumer lawyer and you'll find a letter and specific instructions. This works only if you can pay the bill or, the amount billed is an error.
http://community-2.webtv.net/Y-chat/WhyChatsCredit/

The next site is www.creditboards.com
Just do a search for HIPPA and Why Chat. One hell of a lot of success stories. I'd guess 2/3's of the people have successfully had their reports cleaned when they paid.
I think it's a bluff {and a hospital administrator whp's on that site agrees} because, at the end of the day a health care provider has the right to collect a debt through a 3rd party.
I just wonder if the prospect of getting paid finally vs the alternative of not being paid plus, the time and effort expended to answer complaints, etc just means a risk/reward decision is being made.
Anyway, just my rambling thoughts. Look at those sites and see what you think. Hard to argue with success!

 

[Ladynred]

Good Morning Bigun

Yes, I think there's a LOT of confusion about HIPAA where CA's are concerned !! HIPAA is HUGE and it carries some VERY large fines for violations - plus FEDERAL jail time if it comes to that. I really do believe that most providers are just willing to forego a fight over HIPAA regs and violations and settle, or remove TL's to avoid a long drawn-out process of actually verifying the legality of what they're doing - or not, as the case may be. They KNOW the risks of being wrong. Even with our compliance dept here, who are up on the Act more than anyone I know, are fuzzy about collections and HIPAA !

I think WhyChat's HIPAA letter success is two-fold - bluff AND a valid legal stance. The fact is, WhyChat's letters work under certain circumstances.

Magzi - you can go over to www.creditboards.com and look for posts on WhyChat's HIPAA letter. WhyChat posts there often, so you can always ask your own questions.

 

[magzi]

Bigun and Ladynred

Thanks. Keep in mind here the issue is not whether a medical provider can use a collection agent it is the release of actual medical information to the collection agent, the diagnosis/treatment, not the fact that you simply had medical treatment and owe money. The date of service and the amount due along with the debtor's name, address and phone number. I am not trying to avoid paying. It's an insurance dispute to begin with.

I have here a situation where a medical provider disclosed diagnosis and treatment to a collection agent. This is a medical provider (ambulance company) that told me that they give the collection agent the entire file. Should some clerk at a collection agent with only a PO box and no known physical address (at least not known to me) have access to medical records? I think not. Who knows where it could wind up.

I am employed in a professional capacity. This kind of information could cost me my career and livelyhood if it got into the wrong hands. Apparently it already has gotten into the wrong hands, beginning with the medical provider. I'll check out those sites. Thanks. Keep the info flowing.