What health information is my health insurance company entitled to?

Question

When I am admitted to a hospital for care, is my insurance company entitled to see my entire past medical history? Are they entitled to view all information (even incorrect assumptions written by consulting doctors who did not even come to see me and wrote incorrect information- mixed me up with another patient) from every visit?

Where can I find legislation regarding what insurance companies are entitled to see? Also what good are HIPA laws is insurance company employees are entitled to see all of our info?

Answer 1

pretty much boils down to if they pay for it, they get to see it.

Answer 2

?? Employers aren't able to see your medical records.  Only the insurance company is.  And yes, their entitled to see them, however insurance companies only request your medical records if they're verifying a claim or you're applying for coverage.  Insurance companies don't otherwise keep your medical records.  The exception would be Kaiser since they are the provider and the insurance company.

And, if a doctor writes something down in your records it is part of your records...correct or not.

http://www.InsurancePickle.com  

Answer 3

~~Since your insurance company pays your medical bills they are entitled to all medical information gathered for your treatment. If you have incorrect information on your forms then call the insurance company and ask them how you get it corrected for their records.~~

Answer 4

Odds are that you signed a waiver allowing your insurance company access to any of your records when you signed up for your policy.  (It was most likely part of your application, and signing it was most likely a condition of getting on the policy.)

Your insurance company will request records from your health care providers on an as needed basis - for example, if you request pre-authorization for a service or if there is some necessary reason to review your information (to determine if a condition was pre-existing or work related, to determine if there was fraud on the policy, etc.)

The HIPAA laws protect you from your medical information becoming public knowledge or disclosed to the wrong people.  However, your insurance company and its employees who have a business need to see medical info don't count as "the wrong people."  (Ex - The receptionist at the front desk of your insurance company likely doesn't have a "business need" to see customers medical information, but medical review and other relevant staff certainly do.)

You are entitled to see a list of who/what companies your information has been disclosed to - the procedure for requesting that info should be spelled out in your health care provider's Patient Privacy handout/booklet.  If you're concerned about something specific, this might be something you want to look into.

But in general, if you expect the insurer to pay your medical bills, then you have to allow them access to your medical records.