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MovingUpward posted 7/14/2014 21:03 PM

My adult dd is on my insurance but is in charge or her copays. She recently went to a specialist that she saw when whe was 14, and that office has sent the charges to me. I signed a guarantee to pay what she was fourteen but not recently. I've called once during m-f office hours but didn't get a response from their billing dept with whom I left a message on an answering machine. So I already find this practice as sloppy.

Now the question is in the last bill I got, a detailed bill for another patient that states tests and procedures performed along with charges. Is this a HIPAA violation and how is it best addressed?

fireproof posted 7/14/2014 21:42 PM

If she is paying her copay then let her pay her copay. If not then discuss with her regarding payment if any owed to you or the office.

As far as the other let the office know and see if they prefer you mail it back in or destroy. I would think they would want to know because if it happened to you it could happen to another patient. Also I would double check or request a detailed bill of her visit to make sure you are paying the correct visit.

The office is like any other business. Privacy rules are important and someone will have to at least be held accountable for the mixup.

If you don't like this practice seek out another one. The nice thing about continuity of care is the history but these days that is a quick transfer of information.

Good luck!

purplejacket4 posted 7/14/2014 22:53 PM

Yep that's a big old HIPAA violation. You need to ask to speak with the office manager. If that doesn't work ask for the head nurse. In many offices the head nurse really is the power behind the scenes.

Jrazz posted 7/14/2014 23:06 PM

Did they send just the copay charges or charges for part or all of the visit? It's a bit sloppy, but... as you were the last one to sign for financial responsibility and it is your insurance policy it kinda makes sense that they sent the bill to you. From a technical standpoint. From a practical standpoint I agree it's sloppy.

Interestingly, even though you now can have your adult child on your health insurance policy until age 26, the healthcare reform act did not override HIPAA’s privacy rights... which means that they are legally bound not to disclose her medical history to you without her consent even if you are the primary insurance policy holder.

That's neither here nor there as you are saying that they sent an ENTIRELY different patient's bill with services listed, right? Oy.

Your medical insurance carrier will have a HIPAA violations department - call the customer service number on the back of your card and explain to them what happened and they will launch a formal investigation. It may sound extreme, but there's every chance that your DD's information was sent elsewhere and now somebody else has her vitals. It's a long shot, but I would monitor her/your credit for a bit. I would also send the bill back with a note saying that you have notified your insurance carrier of the error.

Blech. No fun. Let me know if you need help.

[This message edited by Jrazz at 11:07 PM, July 14th (Monday)]

Kajem posted 7/15/2014 01:06 AM

It's sloppy billing. All my adult children on XH's insurance get the bills for their co pays. Once they became adults the individual doctor offices sent them the statements.

Thinking as I'm writing, I don't know that XH removed himself as guarantor- oh hell he never guaranteed payment. That was my job.

Is there a state agency to report the dr for HIPPA violation?


MovingUpward posted 7/15/2014 05:38 AM

For clarification, I had both my DD's and another unrelated Patients billing statements with details.

tushnurse posted 7/15/2014 07:25 AM

While it's a HIPAA violation, it is actually a mistake, and not intentioned on their part, sloppy yes, fineable not really.
HIPAA rules are very clear what is and isn't a breech of them, However .....To acutally make a claim that actions were intentional to break them is not often found.

You SHOULD speak to the Office Manager. Let them know you have someone elses bill and their account number. Shred it, let them reprint and send. The other thing is a lot of offices use an outside source to handle their billing, and billing issues, and if it's a major medical network, it is often done at a centralized location. The OM should be able to direct you though.
If you signed the form of financial responsibility, and your the last one to do so, you are on the hook for the bill. HOWEVER if anyone has signed one since, you are not responsible for the bill, at least in my state.
The financial responsibility form and the HIPAA forms should be different forms, and often will have different information on them. I would ask for copies of anything they are claiming your name is one. You have a right to those.

You may be able to barter the bill down as well, given their crappy response time, their mistake, and breech of HIPAA> They may just want to make it all go away if you raise a stink.

Kajem posted 7/15/2014 07:33 AM

Were they stuck together in the same mailing?

It's still a HIPPA violation. Accidental, still sloppy office billing.

Does the other patients statement have an address? I think I would send it to them with a note explaining that it was in your DDs statement, and you contacted the office but they are not responding.

The reality is the office discussing this with you MAYBE another HIPPA violation. Let the person who had their privacy betrayed deal with the dr office. Hopefully that will make the billing dept more aware when sending out statements.


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