Doctor/Patient Privacy, No More

[OULobo]

Wrong. You've signed over all your medical information to your insurance company...every claims reviewer, utilization reviewer, clerk and telephone operator.

Do you think they're bound by the same oath as your attending physician?

Try applying for life insurance. Courtesy of your health insurer, your medical information is an open book.

HIPA codes restrict who the insurance industry can give your info to. They wouldn't even give me my own info! Claims reviewers, clerks and telephone operators are only privilaged to the billing code for any proceedure (although that code is somewhat discriptive, it is a code that groups proceedures into large vague catagories), not any info that is specific to the proceedure. If there is a claim judgement to be made, it must go through a doctor, as only a doctor is considered qualified personel to make those decisions. As he is a licensed MD he is still bound by the oath. It's all in the insurance company's privacy policy and the federal laws.

 

[Kenpodoc]

HIPA codes restrict who the insurance industry can give your info to. They wouldn't even give me my own info! Claims reviewers, clerks and telephone operators are only privilaged to the billing code for any proceedure (although that code is somewhat discriptive, it is a code that groups proceedures into large vague catagories), not any info that is specific to the proceedure. If there is a claim judgement to be made, it must go through a doctor, as only a doctor is considered qualified personel to make those decisions. As he is a licensed MD he is still bound by the oath. It's all in the insurance company's privacy policy and the federal laws.

Fabulous optimism. I have insurance companies that insist on a copy of every patient note before they will pay the claim. The patient can choose not to give permission to send the note but then their insurance won't pay. I know that a doctor doesn't review every note personally. I used to put little personal notes in every chart to help me keep track of personal information, Ie. going on cruise to greece. I leave these out now because every chart has become open to the prying eyes of insurance companies.

Don't feel too comfortable about insurance company physicians reviewing the records. Physicians like martial artists are very competitive. When they work for the insurance industry they frequently forget that they have an obligation to the patient that they have never met and find themselves competeing to be the best for the insurance companies interest. I'm personally not sure that a physician can work for an insurance company and not, by that jobs very nature, violate their H. oath.

As to the initial story starting this thread, Pennsylvania may have a law requiring physicians to report at risk drivers. Physicians are often put in difficult positions where any decision they make violates either the law or their physician patient relationship. I think that some of the information in that case is missing since a six pack a day habit would keep most of the drivers off the road in the PA town I grew up in.

Jeff MD

 

[kenpo tiger]

My best friend is an RN and works for a company which does insurance claim review. Her job is specifically to review claims to determine whether they are medically warranted as well as the duration of the patient's stay in a facility and aftercare, if any. She does not discuss the details with anyone - even me, who's close as a clam when it comes to being told things - because she feels it is her obligation to be discreet and that she is bound by her professional ethics to conduct herself in a professional manner. Now, I know that the MDs in this forum will have something to say about RNs vs. MDs, but know that my friend and I also have a close friend who is an ER doc - at St. Vincent's in Manhattan as well as one or two other places - and she fully agrees that RNs sometimes know as much, if not more, and are more discreet at times than some MDs. KT

 

[OULobo]

- and she fully agrees that RNs sometimes know as much, if not more, and are more discreet at times than some MDs. KT

I'd agree in the areas of practicality and experience, but the indepth knowledge I would say is still with the MDs and DOs.

 

[Kenpodoc]

My best friend is an RN and works for a company which does insurance claim review. Her job is specifically to review claims to determine whether they are medically warranted as well as the duration of the patient's stay in a facility and aftercare, if any. She does not discuss the details with anyone - even me, who's close as a clam when it comes to being told things - because she feels it is her obligation to be discreet and that she is bound by her professional ethics to conduct herself in a professional manner. Now, I know that the MDs in this forum will have something to say about RNs vs. MDs, but know that my friend and I also have a close friend who is an ER doc - at St. Vincent's in Manhattan as well as one or two other places - and she fully agrees that RNs sometimes know as much, if not more, and are more discreet at times than some MDs. KT

Most LPNs RNs MDs DOs are discrete. A few aren't but that is not related to degree. The problem now is that so many people have a legal right to review a chart it really is no longer private. I don't let anyone look at a chrt without patient permission, but frequently they have no choice but to give it. The insurance company has them in a financial choke hold.

Jeff

 

[Han-Mi]

He's A Witch