The Ohio Money case where a contractor found money in a homeowner's wall, they argued over who got what and since some of the envelopes were labeled with the money man's name, his heirs made a successful bid for a portion of the money. So what does this have to do with HIPAA? HIPAA is a pet peeve for me. An overpriced (in terms of the cost of its administration) , overwordy legislation that more often than not works against families. This is not surprising since HIPAA is mostly a financial document. How do we know this? Read the legislative introduction to HIPAA:
To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes.
Internal Revenue code? That doesn't sound warm and fuzzy in terms of patient privacy. Combat waste and fraud? Doesn't sound like a privacy issue. Promote use of medical savings accounts and "improve access" to long term care? It's a money thing. Okay, it's law, we have to live with it until someone wises up. So where does that leave the old fashioned "next of kin" designee whose name appears on the medical forms for millions of family members? Not in great shape.
Next of kin got the Ohio heirs some money, not all, but that was based more on the fact that the ownership of the property, the money they received was established by the name on the envelope holding their portion rather than being unlabeled money in a wall. Next of kin remains the key to inheritance in cases where there is no will, or other legal designation of who gets specific property. But in terms of acting as a surrogate to make medical decisions for someone who is incapacitated, next of kin may be better than stranger but is often not persuasive: Therefore hospitals provide form after form trying to get patients' wishes on paper and we help by providing health care proxies, or power of attorney forms. These forms are critical in establishing our "RIGHTS" to communicate on behalf of the patient regarding his medical treatment, regardless of who is his/her next of kin.
But HIPAA complicates this paperwork. As every parent who pays for medical insurance for a student aged 18 and over knows, access to information about insurance policies is stopped by HIPAA. Even regarding payment of bills I recently had a HIPAA excuse put forth. Similarly, in the case of a patient who is incapacitated, access to health insurers, INCLUDING long term care insurance providers is dependent on having documentation. This result works against family assistance for someone who is incapacitated. Further, health insurance communications are about PAYMENT for medical services for an insured who has paid premiums. But, as we know, insurers will use HIPAA to avoid payment like they use every other law passed to help their bottom lines, so get that documentation.
Everyone needs to have a health care proxy or durable power of attorney for health care decisions for every insurance policy that specifically addresses that the document is intended to meet HIPAA verification rules, even if you are "NEXT OF KIN." During benefits season, each of us should update this documentation.
If you contact an insurance company on behalf of an aging parent, child, or even spouse, know that you will have to provide more information than the information that you are "next of kin."
And while we wait for modification or eradication (one can dream) of HIPAA, which has ended up being what in fact it was intended to do, a money law that more often than not protects insurance companies, like the Ohio homeowner and her contractor, try to work these things out without having to leave decision-making to some unknown third party whether lawyer or stranger and get the documentation.
