Patient Doctor Privacy

  • Posted by a hidden member.
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    Jun 20, 2010 12:45 AM GMT
    I'm in college and still under my parent's health insurance and I'm thinking I need to tell my doctor about some issues but telling him would mean I need to tell him I'm sexually active. Last time I went to the doctor my mother went in with me to ask for advice on a problem she had (please no comments on my mothers cheapness or nosiness LOL) so I couldn't say anything about be actually being sexually active much less that I'm bi or that I drink.

    My question is: how private are my medical records. Can my parent's see them? If so in what case could they see them?
  • Posted by a hidden member.
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    Jun 20, 2010 2:14 PM GMT
    Just call up the health insurance and the doctor's secretary and they'll tell you. My mum used to come in with me too, that way we saved on paying for two appointments!
  • Posted by a hidden member.
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    Jun 20, 2010 2:25 PM GMT
    You are an ADULT.. your parents have NO access to your medical records unless you give the doctor permission..
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    Jun 20, 2010 2:43 PM GMT
    If you're concerned read up on HIPAA. Since you're an adult, your medical records are protected by federal law meaning your parents can't have access to your records without your written consent.
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    Jun 20, 2010 2:47 PM GMT

    From a legal and ethical perspective, your medical records are completely confidential.

    However, speaking practically, the situation you presents a few issues. First, it is pretty remarkable that your doctor would speak to you with your mother present without creating at least some opportunity for you and the doctor to speak privately for part of the meeting. By failing to do this, your doctor leaves open the possibility that you will fail to talk about concerns that you might find awkward to talk about with a parent in the room. (Substance use, sex, mental health issues and domestic abuse come immediately to mind.)

    Someone else has mentioned calling the doctor's office in advance of another appointment. That sounds like great advice. Another idea is to seek out a free or low cost clinic near where you live that you can visit on your own.

    It's great that you are trying to find a way to have your concerns addressed privately and professionally. I hope it all works out for you.

  • Posted by a hidden member.
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    Jun 20, 2010 10:28 PM GMT
    Ask for and read your health care provider's "Notice of Privacy Practices" (NOPP) as they are required to maintain under the "Privacy Rule" promulgated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Also note, that just because you are an adult, if your provider's NOPP states that they may share your information with persons or entities involved with your treatment, or in payment for your treatment, then your folks may still have a right of access to your health information.

    You may request from your provider (in advance) a restriction on a confidential conversation. If your health care provider agrees to the restriction, then others who may have had rights to your medical information for treatment, payment, or "health care operations" purposes would not be permitted access to this additionally restricted information.

    You have the right to request the restriction. The provider does not have to agree to the restriction. However, if the provider agrees, then they must abide by that restriction. The provider at a later time can unilaterally rescind the restriction on future information, but any and all information conveyed to the provider during the time the restriction was in effect is still protected by the restriction.

    Health care providers and others who make unlawful disclosures of protected health information may be subject to civil and criminal penalties under HIPAA.

    Certain health information (i.e. mental health, HIV, STD, genetic information) may be further protected under other State or Federal statute or regulation.

    If your health care provider is also an educational institution, you may have additional rights under the Family Educational Rights & Privacy Act of 1974 (FERPA).

    Please feel free to email me if you have additional questions. I am a health care privacy and security professional.

    Aloha and Be Well!

    Alan


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    Jun 21, 2010 1:48 AM GMT
    Thanks so much for your replies guys. This has been so very helpful, I'll let you know how it goes after i get back from the doctor tomorrow.
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    Jun 21, 2010 1:53 AM GMT
    Just be aware that your parents will receive records from your health care insurer detailing the cost of any lab work, i.e., medical tests. Since you are on their insurance, they may also receive a bill from the lab for whatever is not covered under insurance, which may or may not contain details of the tests performed.
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    Jun 21, 2010 2:22 AM GMT
    viveutvivas saidJust be aware that your parents will receive records from your health care insurer detailing the cost of any lab work, i.e., medical tests. Since you are on their insurance, they may also receive a bill from the lab for whatever is not covered under insurance, which may or may not contain details of the tests performed.


    Was just gonna say this. Though they don't have access to your medical records, they will, for sure, receive in the mail any billing that comes through the insurance, so if you do have to have any work done or need any prescriptions or anything like that, they'll see these things, and probably ask about them (if they aren't detailed already- mine usually aren't very descriptive). I'd still talk to your doctor though, and take it from there. Like someone said, you can always find a free/confidential clinic if you actually need any tests done.... good luck man.
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    Jun 21, 2010 2:27 AM GMT
    viveutvivas saidJust be aware that your parents will receive records from your health care insurer detailing the cost of any lab work, i.e., medical tests. Since you are on their insurance, they may also receive a bill from the lab for whatever is not covered under insurance, which may or may not contain details of the tests performed.


    A patient can limit the information given to third party payers (i.e. parents) to the amount of the charge, the date of the service, and the name of the provider. The diagnosis and treatment information is not considered the "minimum necessary" in regards to payment by a third party payer.
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    Jun 21, 2010 2:29 AM GMT
    FYI, it is probably best to avoid the legal wrangling and go with a public health clinic and anonymity. Check with your local HIV/AIDS services organization for information and referrals.
  • gaydocalex

    Posts: 80

    Jun 21, 2010 12:12 PM GMT
    I had a 26 year old patient who used to come to every appointment with his mother. I needed to ask some personal questions so I always had to throw her out. One day during a treatment for his lupus she wanted to hold his hand during the infusion. It was getting kind of ridiculous. She made all his appointments and I had to call her with all the lab results. Finally, at one visit when she was sitting next to him holding his hand in MY chair in the exam room, I asked her if she wouldn't mind moving across from her "boyfriend" for a moment. It was obnoxious of me. She looked at me like I was crazy and then said sheepishly "but he's my baby". I said that I promise I will take very good care of her Baby...... she never came to another doctor visit again. The patient is doing great medically and personally. It was a moment that helped him get some balls to grow up a little.
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    Jun 21, 2010 12:32 PM GMT
    Everything people said about HIPAA is true. Your records are 100% confidential and they only way anything can be disclosed in them is if they have written permission from you.
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    Jun 21, 2010 9:14 PM GMT
    I just got back from the doctor and things went well and he assured me my records were private. Although I didn't tell him about my sexuality (I just wasn't able to bring the conversation to that) I was able to talk to him about other rather awkward things. I figured I would save the awkward conversations and spread them over several visits. icon_smile.gif Thanks again guys.
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    Jun 22, 2010 12:53 AM GMT
    collegeRedHead saidI just got back from the doctor and things went well and he assured me my records were private. Although I didn't tell him about my sexuality (I just wasn't able to bring the conversation to that) I was able to talk to him about other rather awkward things. I figured I would save the awkward conversations and spread them over several visits. icon_smile.gif Thanks again guys.



    Glad you were able to set your mind at ease about your records privacy...
    If this person is truly your physician, you need to be honest from the start with him. If the Dr can't handle your bi-sexuality or your drinking or whatever else...I would dump his ass in a "New York Minute" and get another.
    Realize that you are now an adult with certain rights to privacy. You are also a consumer, purchasing a service...being the skills, knowledge and opinion of the physician. You are allowed to shop around to find the right one, that is open minded and non-judgmental and has a bedside manor that is agreeable to you. ( as well as fits your insurance and economic realities, etc...)

    My Doc is one of the Team doctors for the Ohio State University Baseball, Football, basketball, Hockey, Wresting and a bunch of other sports. He is GREAT and really easy to talk to about anything. I have had him as my doc for about 4 years. The first conversation I had with him was that I am gay and I wanted to know if it was an issue for him... His answer was "not an issue", since he worked at the AIDS clinic as a resident and still to this day 2X a week.......I have had conversations about drinking, smoking pot, skin cancer, my weight loss, running marathons, knee pains, runners nipple, etc.....you name it and we have talked about it. After our introductions, he said he would like to have me as a patient. I told him That it will only work if I can be totally honest every time with him and he said that is the only way it does work.....
    My point is, that you need to develop a relationship with your doctor that is honest from the beginning.
    I doubt there is anything about your anatomy or experiences or questions that he hasn't seen before or had asked of him before...so it is most likely "awkward" only for you....so grow up and take charge of your health care....... Good luck!
  • Webster666

    Posts: 9217

    Jun 22, 2010 3:14 AM GMT
    When you are an adult, NO ONE but you and your doctor is allowed to see your medical records. It's the law. It's known as the doctor/patient privilege. Even in a court of law, unless you give your consent, your medical records are private and cannot be used as evidence.

    I would suggest that you schedule a private appointment with your doctor, without telling your mother.
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    Jun 22, 2010 5:54 AM GMT
    SAHEM62896 saidEverything people said about HIPAA is true. Your records are 100% confidential and they only way anything can be disclosed in them is if they have written permission from you.


    HIPAA defines that protected health information may be used or disclosed: 1. As permitted by regulation; or, 2. As specifically permitted by the patient.

    "As permitted by regulation" is a hole that you can drive a truck through (especially when it comes to family members).

    Don't assume that your records are "100% confidential".
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    Jun 22, 2010 5:58 AM GMT
    Webster666 saidWhen you are an adult, NO ONE but you and your doctor is allowed to see your medical records. It's the law. It's known as the doctor/patient privilege. Even in a court of law, unless you give your consent, your medical records are private and cannot be used as evidence.
    ...


    There are specific permissions by regulation that allow access by lawful order of a court, statute, or regulation at the Federal and State levels. In some cases, laws mandate the disclosure of certain medical events and conditions.

    Don't assume that medical records are completely confidential.

    Know your rights according to the "Notice of Privacy Practices" of your health care provider or insurer.
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    Jun 22, 2010 2:21 PM GMT
    GAMRican said
    Webster666 saidWhen you are an adult, NO ONE but you and your doctor is allowed to see your medical records. It's the law. It's known as the doctor/patient privilege. Even in a court of law, unless you give your consent, your medical records are private and cannot be used as evidence.
    ...


    There are specific permissions by regulation that allow access by lawful order of a court, statute, or regulation at the Federal and State levels. In some cases, laws mandate the disclosure of certain medical events and conditions.


    Yes, for example, in certain states HIV is a reportable infection.

    Also, since doctors communicate medical conditions to insurers, and insurer databases are shared and anything but safe or confidential, you should assume that any diagnosis requiring care paid for by an insurer becomes public knowledge.

    For this reason, it may be a good idea to pay out of pocket for certain tests. In fact, at the lab I go to in my state, for privacy reasons, HIV tests are not sent through insurance but paid out of pocket (a token amount of $20). I believe this is required by state law.
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    Jun 22, 2010 7:14 PM GMT
    viveutvivas said

    Also, since doctors communicate medical conditions to insurers, and insurer databases are shared and anything but safe or confidential, you should assume that any diagnosis requiring care paid for by an insurer becomes public knowledge.

    The above statement is not correct. Protected Health Information (PHI) used or disclosed for a specific treatment, payment, or "health care operations" purpose, may not be used or disclosed for any other purpose unless specifically permitted by regulation or authorized by the patient. PHI maintains protection as it passes between health care providers and health plans (and "health care clearinghouses", but that's not really germane to this topic). PHI can only become "public knowledge" in one of two ways. 1) If a patient authorizes disclosure to a person or entity that is not covered under HIPAA. At that point, the information could be used or disclosed further unless the individual has another agreement in place with the receiving person or entity. Certain health information does maintain protections (i.e. substance abuse, mental health, HIV, genetic information) once disclosed to persons or entities not covered by HIPAA, but those protections are afforded by other Federal or State legislation or regulation. 2) An unauthorized disclosure occurs (i.e. theft of medical record information. In this case, there are both civil and criminal penalties that may be applied as a remedy either through a U.S. Department of Health and Human Services administrative action, or a U.S. Department of Justice prosecution.


    For this reason, it may be a good idea to pay out of pocket for certain tests. In fact, at the lab I go to in my state, for privacy reasons, HIV tests are not sent through insurance but paid out of pocket (a token amount of $20). I believe this is required by state law.

    There are entities that offer certain anonymous health care diagnostic services either free of charge or on a sliding scale. Please consult with your local health department or HIV/AIDS services organization for more information. Laws vary from state to state. Your local health department or HIV/AIDS services organization can give you more authoritative information.

    Aloha and Be Well!
    Alan

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    Jun 22, 2010 9:03 PM GMT
    GAMRican said
    viveutvivas said

    Also, since doctors communicate medical conditions to insurers, and insurer databases are shared and anything but safe or confidential, you should assume that any diagnosis requiring care paid for by an insurer becomes public knowledge.

    The above statement is not correct. Protected Health Information (PHI) used or disclosed for a specific treatment, payment, or "health care operations" purpose, may not be used or disclosed for any other purpose unless specifically permitted by regulation or authorized by the patient. PHI maintains protection as it passes between health care providers and health plans (and "health care clearinghouses", but that's not really germane to this topic).



    I'm not sure I understand. How does a new insurer find out about a preexisting condition if health information is as private as you say?

    What does "specifically permitted by regulation" mean? It can only mean a weakening of the expectation of complete confidentiality, not a strengthening.
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    Jun 23, 2010 3:28 AM GMT
    viveutvivas said
    I'm not sure I understand. How does a new insurer find out about a preexisting condition if health information is as private as you say?

    What does "specifically permitted by regulation" mean? It can only mean a weakening of the expectation of complete confidentiality, not a strengthening.


    Good questions, V.

    Answers are in indigo.

    For your first question...

    Definitions:
    Plan Sponsor - Generally, an "employer", but not all plan sponsors are employers.
    Pre-existing conditions - Generally, a diagnosis for which medical care has been received for a period of time in advance of a coverage event.
    Covered Entities: Individuals and Entities that are specifically indicated by law to be subject to the HIPAA statute and any regulations promulgated under the statute. These are "Health Care Providers", "Health Plans", and "Health Care Clearinghouses". As of February 17, 2010, "Business Associates" of covered entities are now also subject to the HIPAA Security Rule.
    PHI - Protected Health Information. This is information that is defined by the HIPAA Privacy Rule that is subject to protection and civil and criminal penalties when those protections are violated.

    Assumptions: The individual is not obtaining insurance coverage through a sponsored group health plan with an agreement with the plan sponsor to waive any pre-existing condition clause; The individual is NOT already covered by a health plan without any pre-existing condition stipulation in effect; The individual has NOT been covered by a health plan for more than 60 days. In short, an individual with no health insurance, and no health insurance for over 60 days. The term "pre-existing condition" varies from health plan to health plan.

    When an individual with a pre-existing condition approaches a health plan, the health plan will perform an underwriting. This is a risk assessment on the individual and any potential dependents. The health plan is permitted to ask about, and receive health information in regards to any pre-existing conditions as a part of the underwriting process. The health plan will use this information to make a policy writing decision. A pre-existing condition clause could be part of this policy writing decision. The individual must answer honestly about any questions asked by the health plan during underwriting, otherwise this could be later construed as fraud and payment for claims for the pre-existing condition could be denied, and any payment previously made could be recovered. This is how health plan legally obtains health information which is private. It is an obligatory and voluntary disclosure that the individual makes to the health plan as a part of the underwriting decision. If the individual does not want to make the disclosure, then the health plan can deny coverage.

    Pre-exisiting condition clauses are nullified by HIPAA when there is no more than a 60 day break in continuous "creditable coverage". In other words, if you have been covered by a health plan for longer than any pre-existing condition clause, then if you change health plans and do not have a 60 day break in continuous coverage, your new health plan cannot impose a pre-existing condition clause upon the individual. This is very important information for those persons who have any kind of health condition that requires continuous management. These individuals do not EVER want to have their health plan coverage lapse, lest they be subject to pre-existing condition clauses.


    These protections generally are addressed by HIPAA Title I
    More information on health insurance reform for consumers can be obtained from the U.S. Department of Health and Human Services at:
    http://www.cms.gov/HealthInsReformforConsume/

    Now, for question #2...

    The HIPAA Privacy Rule generally takes the approach that healh care providers, health plans, and "health care clearinghouses" ("covered entities") may not use or disclose PHI for any purpose outside of what is "specifically permitted by regulation", or specifically authorized by the individual.

    Information for consumers about the HIPAA Privacy Rule can be obtained from the U.S. Department of Health and Human Services at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

    A summary of the HIPAA Privacy Rule regulations is available from the U.S. Department of Health and Human Services at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/privacysummary.pdf

    And for you die hard masochists, the actual combined text of the HIPAA Privacy Rule regulations as stated in the Code of Federal Regulations (45 CFR Parts 160, 162, and 164) can be found at: http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/adminsimpregtext.pdf

    "Specifically permitted by regulation" pertains to the use and disclosure of PHI for certain activities that have been identified as being central to the processes of delivering health care (treatment, payment, and "health care operations". These are routine uses and disclosures.

    Additional activities have been identified as being necessary uses and disclosures for non-routine purposes.

    All routine and non-routine disclosures will be communicated to the individual in the form of a "Notice of Privacy Practices".

    As to your viewpoint that HIPAA "weakens" our privacy...

    Previous to HIPAA, Congress performed a study which indicated that individuals were avoiding healthcare due to reasons associated with privacy and possible loss of insurance coverage. Congress found that not only was there unnecessary human suffering and lower quality of life for Americans, but that the cost of healthcare was higher when people did not get early diagnosis and treatment of health issues. Congress also noted that life-spans of Americans could be higher if people got more healthcare. Sadly, it comes down to dollars and cents. If people are healthier and live longer, they produce more tax revenue for society and present less of a liability to the Medicare and Medicaid trust funds. During this period, the privacy of an individual's health information varied from state to state. HIPAA was meant to put into place a "floor" of privacy rights. People in those states that had stronger protections could still keep those protections. People in those states that had weaker protections or no protections would now have protections. And, there are Federal Civil and Criminal penalties to back these rights up.

    Overall, HIPAA has provided the consumer with protections over their medical record much like those over their credit report. And, with the civil and criminal penalties against unlawful use or disclosure, you the consumer have recourse that you did not have previous to 2003.

    The results have been quantified 14 years later as having been a net benefit to the quality of life and to the improved efficiency of the health care system.

    New provisions included in the American Recovery and Reinvestment Act now provide the consumer with even more protections and provide incentives for health care providers that make "meaningful use" of Electronic Health Record technologies (which can protect medical records to a higher standard of care than old fashioned paper records).

    Sorry about the long post, everybody. B