Hungry, Hungry HIPAA

I guess I'm not doing a lot of political pieces this week for some reason, perhaps because there's not a lot in the news and I don't have any really great insights to add on events like the North Koreans sending the remains of possibly 55 servicemen from the Korean War.  We could ask why they weren't sent back in, you know, 1957 or so, but those decision-makers are all dead now.

So ... I may have mentioned it in an earlier piece, but back in March my best girl broke her wrist in a bicycle accident.  It was actually a stationary bike, which would make it kind of funny to everyone but her.  In fact, though, it was quite excusable, being the first time she had used the new bike, and it was rather high for a diminutive user; the first time she tried to get off it, her foot caught as she was lifting it to dismount and the whole bike fell over with her attached, sending her to the wood floor and breaking her wrist in two places.

Long story shorter, she had a cast on it for a few weeks, and then a couple months of therapy with a hand-therapy specialist to regain as much motion and flexibility as possible.  It will never be back to normal, but close enough.  And that brings us to today.

Earlier this week, with all the therapy behind her, my best girl got a call from our health insurance company.  I say "our", but that's not quite accurate.  We're both on Medicare, same company and same plan, but Medicare is an individual thing; her policy is hers and not some kind of dependent case off mine.  So she has to talk to them regarding her records; I cannot.

The company, which shall remain nameless, is one of the handful of remaining companies that does the Medicare Advantage plans, which wrap around Medicare and add some coverage that Medicare doesn't do, and offers the benefit of handling all the government stuff and insulating you from their billing.  That is a good thing.

But the call that the missus got was from the insurance company, and asked if she had had a "bone density" test to check for osteoporosis.  Now please note that she didn't fall and break a hip; she tripped while dismounting an exercise bike and broke her wrist when it hit the wood floor.  My wrist would have broken and so would yours, no matter how porous or solid your bones may be.

So she explained all that to the insurance company caller in so many words, some of them fairly choice (she is, after all, Italian).  No, she said, she didn't need a bone density scan since the fall was an accident and the break was clearly not related to brittle bones.  Yes, she understood, they would routinely call in case of a bone break in someone past 65, but she was fine.

That should have ended it.  Except the next day, she received a call from our family physician.  Apparently they had been notified by the insurance company that she had broken her wrist and completed treatment and subsequent therapy, and that she needed to have a bone density scan.

Needless to say, she went through the roof.  All the treatments for the wrist and subsequent PT had been through an orthopedic group.  Her family doctor had not been told about the fall, nor was there any reason to have told him until her next checkup, and that would be months later -- and by her.  Why did the insurance company feel the need to contact her doctor to make sure she had a bone density test?

FTM

Yes, follow the money.  Sure, the patient said she didn't need the test and didn't want the test.  But apparently the insurance company doesn't get paid unless there are actual medical procedures done, I guess.  Or something relating to payments, or some other way that the company ultimately makes money, aside from just the premium.

So for some reason, the company took what seems like the strange additional step of calling her family doctor, who had not even been involved to that point, and telling him to get her to do a bone density test.

There is this thing called the Health Insurance Portability and Accountability Act, or "HIPAA", which gets misspelled all over the place.  Essentially, it is supposed to govern the transmission and privacy of medical records, and what can and cannot be transmitted between practices without patient approval.

I assume that this somehow didn't violate HIPAA, but I'm not sure how.  Perhaps there is something on file with the insurance company allowing them to communicate to her family doctor.  Perhaps it is because the orthopedic practice and the family practice are part of the same large medical service alliance.

But she sure has heck did not authorize the insurance company to contact her family doctor when she already told them she didn't need a bone density scan.  And it creeps her out, not to mention me, that they would do such a thing, for no other perceptible reason than to get her to take a test that she does not need, for no obvious reason except money.

And that this must happen all the time.

Copyright 2018 by Robert Sutton
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