ALT="HIPAA, The Insurance Problem Solver"HIPAA is the acronym for a broad body of federal law, The Health Insurance Portability and Accountability Act that has existed since 1996. Because it is a federal law it applies in all states.

Like many laws, HIPAA covers several topics. Some of them are not directly connected with each other, but there are some that have common threads. One of the threads ties together health insurance, the delivery of health care services, and the confidentiality and sharing of personal medical information. That’s the one we will discuss here. Interestingly, HIPPA does not now apply to life insurance, long-term care insurance, or various other kinds of insurance that implicate a person’s health condition.

What Is HIPAA For?

Doubtless, you have encountered HIPPA when you have gone to a doctor’s office or a hospital. You were asked to sign HIPPA-related forms that you may not have understood. You may also have periodically received HIPPA-related forms from your health insurance company. You may have even been told not to stand too closely to the person ahead of you at a doctor’s office check-in desk so that you did not see the written information that he or she was providing. In their own way, all of those things have to do with HIPPA.

Dealing with a medical issue, and certainly, dealing with health insurance is difficult enough, without also being confronted with the complexities like HIPPA. Therefore, The Insurance Problem Solver (TIPS) wants to make it a little more understandable.

One of the main purposes of HIPAA is to guard the privacy, dissemination and to notify patients of when and how “individually identifiable health information” can be used. The law defines that information as:

…information, including demographic data, that relates to:
• the individual’s past, present or future physical or mental health or condition,
• the provision of health care to the individual, or
• the past, present, or future payment for the provision of health care to the individual,
and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).

HIPPA applies to “covered entities.” The statute defines them as:
• A healthcare provider (physician, hospital, etc.)
• A health plan (a health insurance company, an HMO, a PPO or some other kind of healthcare payor)
• A healthcare clearinghouse.

A healthcare clearinghouse is an entity that acts as a middleman between a healthcare provider and another entity that needs the information of a healthcare provider. The other entity might be an insurance company that has to pay the provider. In that case, the clearinghouse translates the information from the provider into a form that the insurance company can understand to evaluate and pay or deny the claim. As an aside, clearinghouses became necessary in part due to the development of standardized coding for many medical procedures. By handling the information, the clearinghouse can get knowledge of the protected medical information and therefore is considered a “covered entity” by HIPPA.

In part, HIPPA is intended to notify the recipient of health care services of the fact that individually identifiable health information can and will be made more “public” than the patient may have realized. The need to share the information between and among various entities has arisen with the growth and the intersection of the medical and insurance industries. Not only does HIPPA serve the purpose of notifying patients of the use of the information, but it puts limits on the unauthorized use and spread of the information by people and entities that it covers.

There is more to HIPPA than we have discussed here–much more, and this blog is not intended to be a comprehensive discussion. I hope, though, it will help you make better sense of the plethora of papers that you get, should read, and may have to sign, from your health insurance company, HMO, PPO and health care provider.

As always, if I can help, call me. I’m Luke Brown, The Insurance Problem Solver.