HIPAA- help ees with claim ?s ???

Bosco · April 2003

I've been given the run around by hhs...does anyone know about HIPAA Privacy as it relates to assisting EES who come to HR to help resolve health claims? Ex: a TPA handles Section 125/Cafe plan processing. Claim is denied & explanation is given. The employee doesn't get it....when the EE approaches the HR, is there any issues with helping them with claims, especially since the employee initiates and provides the PHI information to the ER? This is assuming that the EES are given the choice to contact HR or the TPA, and they choose to discuss it with HR.

I've looked and looked and have been unable to locate this issue in any resources....can someone please help????

Thank you very much!!

POPEYE · April 2003

My understanding, if you can understand all the REGS, is that the answer to your question will depend on how you have written your summary plan. If you wish to discuss anything about EOBs or coverage or anything which might lead to obtaining PHI, then you must have that written in your plan document, you must have appointed a privacy officer and a contact person and both of these must be trained. We have decided that we pay a premium for our TPA to handle this and therefore we will not discuss anything pertaining to PHI with our employees. We only take the summary information for enrollment / disenrollment to pass on to the TPA.

Mentel · April 2003

I went to a session held by a Wisconsin insurance broker and was conducted by an attorney with a large Milwaukee law firm. According to him, if you are working on getting a claim paid, HIPAA does not apply. I have also found this true in the regulations that I have read.

Zanne · April 2003

We will assist employees only AFTER they give us permission to see their PHI. This will be in a signed release.

Sad isn't it?

Zanne

Sunny · April 2003

Zanne:
Do you have a copy of a release? I could make one up but I think I'd feel more comfortable with someone else's expertise on this. I see EOB's etc. all the time while assisting employees to resolve insurance issues. Our corporate folks have not developed a policy although my local BC provider did send out notices some time ago - I don't feel personally protected.

Thanks - any help would be appreciated.

Gracie · April 2003

Your plan document would have included your HR role to be able to use and disclose PHI. In cases like these, you can always have the employee sign a Release of Authorization on the spot and then discuss his/her case with the TPA. Your TPA would have prepared all these documents for your use.

If you would like a sample copy, please give me your email address, I will be happy to send it to you.

keithlf · April 2003

Gracie please e-mail me a copy of the release. [email]lewis.keith@cmcsg.com[/email]

Thanks

scottorr · April 2003

I agree with haveing the employee sign an authorization on the spot. Although our HR people do not generally see any PHI, we have asked and trained all of them to get an authoriztion prior to assisting. Even before HIPAA our department policy was to redirect employees to contact the carriers directly. We have signed business agreements with all of our carriers including our FSA.

Sunny · April 2003

Gracie:

My email address is [email]SGwaltney@macleanpower.com[/email]. Thanks.

ladyzuesse · April 2003

Please send me a sample if you have time. [email]tcolson@oldcastleglass.com[/email]

tammy

dowdyk · April 2003

Could you also email me a copy of the release.

[email]kent@theprintinghouse.com[/email]

Kent

thomas · April 2003

I would also love to have a copy of your release. Thanks!

e-mail: [email]lpaquin@ruralresources.org[/email]

fax #: 509-684-4740 (attn: Lorie Paquin)

LindaS · April 2003

In the training sessions I have attended when this question has been brought up is that you should have a signed authorization from the employee allowing you to discuss this information with your TPA. Your TPA should have some sample authorization forms for you to use. The authorization form allows the ee to state who can have access to this information and for what purpose(s). It also provides a timeframe for the authorization to be valid. In addition, if you have been appointed the privacy official/contact person, you should not be the person who makes decisions regarding hiring, firing, promotions, etc. and if you are, there needs to be some type of policy relating to the fact that you will not use this information in any way when making these types of decisions.

Good Luck.

bethann · April 2003

our health care carrier sent me a written release that the ee has to sign authorizing the administrator (you) to call on claims. it really is a headache..and who need the additional paperwork!

POPEYE · April 2003

That is why we have chosen the path not to EVER have access to PHI. We will be sending a Privacy Notification Letter (when I get it composed) to all covered EEs advising them that any and all contact will need to be between them and our TPA or the issuing company. As I said before, that is what we pay them for so why not use them.

Leslie · April 2003

Could I please have a copy also? [email]lostrander@fmcasino.com[/email] Thanks!

HIPAA- help ees with claim ?s ???

Comments