CBG is so correct. HIPAA, even given all its flaws is a law that provides much protection. My goodness, think back 20 years ago...people felt locked into "going nowhere" jobs because of pre-existing conditions--either themselves or a covered dependant. Folks now have much more freedom to change to upward mobility positions because of HIPAA.
For a healthcare practitioner, the April 2003 changes in privacy laws (applicable only to certain groups until 2004), these privacy changes mean (should mean) virtually nil. All of this was already in practice (or certainly should have been). Confidentiality has always been a serious concern of health care practitioners. I agree, our government, in its infinite wisdom acts without thought. The new privacy regulations are a nightmare because of poor writing and even poorer interpretation. Once again, look at the interpretation of the word "REASONABLE". Good grief, very broad in itself. With the new HIPAA regs, 'reasonable' went to 'completely unreasonable' for many in an attempt to avoid possible sanction. Yet, sanction is based on a complaint by complaint basis. There are no "privacy police" out there,watching every move. Reasonable and prudent can be demonstrated in many ways with many differing protocols.
Although far from perfect, managed healthcare is what it is. Not all insurance companies want to, try to, or do direct heathcare. Most simply want to provide the proper healthcare that saves the plan AND the INSURED dollars. The networks set up at contracted rates usually provide insureds with primary, secondary, and tertiary care at designated facilities. Can anyone, physician, patient, nurse or otherwise determine that for example, Johns Hopkins would be superior in cancer treatment to MD Anderson? No. So, why not use the designated network facilities? Lastly, if a plan provides for a life-time maximum, should not that maximum be guarded judiciously? Try being a 30-year-old bone marrow transplant candidate with a lifetime maximum of $1,000,000.00. Potentially gone in no time. If the tertiary care facility recommends VAD chemotherapy that is available within the PPO, why not provide the VAD within the PPO rather than at the tertiary facility, at a greatly reduced cost? Or if a piece of DME may be provided at half the cost in network vs. out of network, why not? One needs to recognize that there is also a problem with providers. What physician wants to be questioned? None. There is (and shoud be) an inherent trust of consumers for their physicians. Yet, when it comes to money, does the physician care for any but his own pocket? Most people are concerned with the insurance company's pocket and perceive it to be very deep. May or may not be true--just like the physicians. The best is for patients to be keepers of their own asset--an insurance plan--by working and communicating with both. Just ask the parents of my 19 year old with a serious closed head injury whom no physicians thought qualified for rehab. I (insurance) fought for rehab. Now he is functioning at a very high level. Fact is, I knew what he qualified for or would qualify for medically and according to insurance. Had they waited, he would not have qualified according to insurance. His parents love me. Letting this boy languish served no one. The higher functional level he achieved the better.
Now, guess what. His dad can look for a better paying job anyway--because of HIPAA. Prior to HIPAA, forget it, end of story. By the way, his dad came to me for advice when looking for that new job--and I'm the insurance person. Evil damn thing that we are.CBG is so correct. HIPAA, even given all its flaws is a law that provides much protection. My goodness, think back 20 years ago...people felt locked into "going nowhere" jobs because of pre-existing conditions--either themselves or a covered dependant. Folks now have much more freedom to change to upward mobility positions because of HIPAA.
For a healthcare practitioner, the April 2003 changes in privacy laws (applicable only to certain groups until 2004), these privacy changes mean (should mean) virtually nil. All of this was already in practice (or certainly should have been). Confidentiality has always been a serious concern of health care practitioners. I agree, our government, in its infinite wisdom acts without thought. The new privacy regulations are a nightmare because of poor writing and even poorer interpretation. Once again, look at the interpretation of the word "REASONABLE". Good grief, very broad in itself. With the new HIPAA regs, 'reasonable' went to 'completely unreasonable' for many in an attempt to avoid possible sanction. Yet, sanction is based on a complaint by complaint basis. There are no "privacy police" out there,watching every move. Reasonable and prudent can be demonstrated in many ways with many differing protocols.
Although far from perfect, managed healthcare is what it is. Not all insurance companies want to, try to, or do direct heathcare. Most simply want to provide the proper healthcare that saves the plan AND the INSURED dollars. The networks set up at contracted rates usually provide insureds with primary, secondary, and tertiary care at designated facilities. Can anyone, physician, patient, nurse or otherwise determine that for example, Johns Hopkins would be superior in cancer treatment to MD Anderson? No. So, why not use the designated network facilities? Lastly, if a plan provides for a life-time maximum, should not that maximum be guarded judiciously? Try being a 30-year-old bone marrow transplant candidate with a lifetime maximum of $1,000,000.00. Potentially gone in no time. If the tertiary care facility recommends VAD chemotherapy that is available within the PPO, why not provide the VAD within the PPO rather than at the tertiary facility, at a greatly reduced cost? Or if a piece of DME may be provided at half the cost in network vs. out of network, why not? One needs to recognize that there is also a problem with providers. What physician wants to be questioned? None. There is (and shoud be) an inherent trust of consumers for their physicians. Yet, when it comes to money, does the physician care for any but his own pocket? Most people are concerned with the insurance company's pocket and perceive it to be very deep. May or may not be true--just like the physicians. The best is for patients to be keepers of their own asset--an insurance plan--by working and communicating with both. Just ask the parents of my 19 year old with a serious closed head injury whom no physicians thought qualified for rehab. I (insurance) fought for rehab. Now he is functioning at a very high level. Fact is, I knew what he qualified for or would qualify for medically and according to insurance. Had they waited, he would not have qualified according to insurance. His parents love me. Letting this boy languish served no one. The higher functional level he achieved the better.
Now, guess what. His dad can look for a better paying job anyway--because of HIPAA. Prior to HIPAA, forget it, end of story. By the way, his dad came to me for advice when looking for that new job--and I'm the insurance person. Evil damn things that we are.
As far as Roy is concerned? Privacy? Limited only to what his publicists allow. ANY person's confidentiality should be preserved--from the Ozark Hillbilly to the Hollywood Star. If Roy has allowed these people to speak for him, the confidentiality is out the window. Now, as a reputable medical practioner, I wouldn't give them the info in the first place................