Question about billing statements in regard to HIPAA regulations in HIPAA Forum

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Question about billing statements in regard to HIPAA regulations

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TampaBayLady	Question about billing statements in regard to HIPAA regulations	Lead	[-]
Posts: 347 May 5 09 7:31 AM Reply Quote More My Recent Posts	Tags : None We have a patient who is 20 years old, and covered under her father's insurance policy, he is the gaurantor for the bill. Her parents are divorced, and she lives with her mother. When she first presented to the office, she informed me that her father was responsible for her medical bills until she turned 21, and to send the bills to his address. She also informed me that her dad's new wife would probably call the office when they got the first bill, and tell me to change the address and send the bill to the patient, but I was to disregard such a phone call. Today I got that call from the new wife. She told me that I was violating HIPAA regulations by sending a bill to her husband that had the daughter's PHI on it. When I told her that the patient themselves had given permission for that PHI(of which there was very little, only a CPT code for an office visit) to be disclosed, she changed her argument. Now she is saying that it is a HIPAA violation to send a bill listing her husband as the guarantor when the patient is over the age of 18, that the bill should be in the patient's name. The new wife does not dispute that her husband is responsible for the bills, she actually read off of the court order she had while on the phone with me, where it said he was responsible for the patient's medical bills until she turned 21. But she keeps insisting our office is violating HIPAA by sending the bill in the husband's name...NOTHING I can find in my HIPAA compliance manual or on the internet backs her up. Am I missing something here? Are we in violation? The stepmom said the father would call me himself about this later this week, and I was hoping to get some information before he did. I really hate these nasty divorces! Thanks in advance for any help.
Steve Verno		#1	[-]
Posts: 10217 May 5 09 5:54 PM Registered User Reply Quote More My Recent Posts	To me, as a layperson, the patient is a legal adult. Im sure the new wife is a legal expert in HIPAA. (Being sarcastic) I would have billed the 20 year old child. You are not subject to any divorce decree. if the father is responsible for the daughters bills, She pays and goes after Dad. If he dosnt pay, she goes to court. YOu could be in violation of HIPAA if you dont have an authorization signed by the adult daughter. We used to get these calls all the time, only from the mother of the adult child. The mother would say, you dont talk to me, you dont get paid. We would say, your son is a legal adult and we cant talk to you without his expressed written permission. The mother would yell. you dont get paid if you dont talk to me. We stuck to our guns. The son would call and send us written approval to speak with his mother. ON a side note, the practice sounds like they need a financial plan to show to the patient or parent. Divorces should be addressed. We always told ex-wives, we are not listed in their divorce, so saying their ex should be billed doesnt cut it with us We would tell the ex to pay and go after her ex. If they complained we would say show me where we are a party to the divorce. They couldnt. As a layperson, I believe we have NO legal recourse if the ex doesnt pay. We dont have a copy of the divorce and we are not a party to the divorce. What do we say in court. The mean ex-husband wont pay his daughters medical bills. The divorce is between the husband and wife not doctor and wife or doctor and husband. I fthe ex is sent to collections, he can dispute the debt. if so, what proof do you have that he owes anything. In my divorce, my ex- virtually lived in her lawyers office, filing motion after motion to send me to jail. I wouldnt send her the maintenance fee of $375 per month out of my $500 per month pay. I paid it to the court and kept my receipts. Federal Marshalls came to my work to constatntly arrest me. IN court, the judge had me released and went after my ex and her lawyer. When my ex refused to let me see my kids, it was so what. She and the kids live in Texas, this is Oklahoma. I said she had no problem filing divorce in Oklahoma. I went to Texas court and they said because I lived in Oklahoma an dthe divorce took place in Oklahoma they were powerless to do anything. My ex sent me her credit card bills I told the credit card companies she was responsible for her own debts after the divorce. That caused another Marshall arrest and weekend in jail. Where was Vito Corleone, Clemenza or Luca Brazi when I needed them. You might wish to speak with a Lawyer that knows HIPAA as we are only laypersons and cannot give any legal advice. Last Edited By: Steve Verno May 5 09 6:07 PM. Edited 2 times.
Doo		#2	[-]
Posts: 6236 May 5 09 8:34 PM Reply Quote More My Recent Posts	The new wife is correct that you should not be billing her husband, but for the wrong reasons. When the patient gives consent for the PHI to be released, as long as you follow their directions, you are not in violation. However, as Steve said, you are not a party to the divorce, the dad did not bring in the daughter and sign that he was financially responsible. You bill the patient (well, actually, you collect the copays UP FRONT) and let her try to get reimbursement from dad. Using that same tactic, I can just imagine trying to tell my daycare provider that I'm not going to pay, my ex-husband is going to pay, oh, and good luck getting blood out of that turnip... but let me drop my daugher off every day anyway. Umm, no. It's not their fight. It's my fight. Now, when dad calls you, I would suggest saying to dad that HIPAA isn't really the issue. The issue is that the daughter wants the father billed, and while you have come to realize that doing that is a courtesy to the patient, it's a courtesy that causes more trouble for your office rather than solving problems. Then ask the father if he wants you to bill him for the copays, and if so, will he pay them within 20 days of receipt of the bill... if he agrees, then I would probably go ahead. If he says no, or he breaks the agreement, then all bets are off and collect from the daughter up front. Then document the entire conversation and put that with the patient's financial records. And for all future patients, just say "no". Sharon Moderator Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.
TampaBayLady		#3	[-]
Posts: 347 May 6 09 7:21 AM Reply Quote More My Recent Posts	Thanks Steve and Doo for your responses, I really appreciate it. To address some of what you said: The daughter has been paying her copays up front, and asking for a receipt so she can then send them her dad to collect them back from him. The bill being sent to him is for co-insurance amounts, which the wife said he has to pay, but apparently she wants me to collect from the daughter, and then the daughter would collect from the dad. I guess what doesn't make sense to me is if the dad is going to have to pay regardless, why there is a problem sending him the bill in the first place, if he is the gaurantor. BUT...now I see that since the daughter is a legal adult, and she signed the patient responsibility portion of her patient form, she should be billed, and can collect from dad. We do have a financial policy in place, and there is a portion of it that says we do not get involved in divorce cases, and that the parent that brings the child in is the one who is responsible. In this case, it is a little different, as the child presented on their own. This is the first time in over fifteen years of doing this that I have gotten a call like this, and HIPAA aside, I was a little taken aback. Live and learn! At least I know that there is no HIPAA violation, as the daughter clearly gave authorization for everything to be disclosed to her father. Thanks again for your help!
Steve Verno		#4	[-]
Posts: 10217 May 7 09 10:51 AM Registered User Reply Quote More My Recent Posts	again. this is a divorce decree issue of which you are not a party to. and the child is an adult. YOu have no guarantees the father will honor the decree. His new wife may intercept any bills that could contain HPI and she is not entitled access. thats all. Again, this response is presented as a layperson and not to be construed as legal advice. One time a woman called asking why her husband was seen in the emergency room. I refused to tell her. i Basically said if he didnt tell you I cant either. Out came the "Im an attorney" card. I stil refused under threat of a lawsuit. She called the health insurance company, they refused. Out came the lawyer card. They told her they didnt care either. They said this was his policy and she wasnt on it. Again, the lawyer card. Same response. He came in due to pain because of an STD. Whether my response is correct or not I dont know, I use common sense. Good luck.
KAbill	Re: Question about billing statements in regard to HIPAA regulations	#5	[-]
Posts: 267 May 11 09 9:03 AM Reply Quote More My Recent Posts	Isn't it as simple as : you bill the insured? Has the daughter been verified as a dependent on the policy under dad's name? Or maybe she's not? I'm not offering an answer or arguing with any previous posts. I'm just really curious now...I would have sent the co-insurance bill to the verified insured's name.
sporty981		#6	[-]
Posts: 2147 May 11 09 10:03 AM Moderator Reply Quote More My Recent Posts	That's a very good point about billing the insured, if you look at it as ok the adult child is still insured under the father's policy because for instance they are a FTS in college. Unfortunately the divorce got dragged into this. Karen Habel, CDA, CMBSI, CDBSI Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.
Doo		#7	[-]
Posts: 6236 May 11 09 3:17 PM Reply Quote More My Recent Posts	KAbill wrote: Isn't it as simple as : you bill the insured? Do you mean bill the subscriber? If that's what you mean, then no, because the subscriber did not come into the office and sign the financial responsibility paperwork. If you mean bill the patient as the insured, then yes, the patient is an adult and signed the financial responsibility paperwork (or if she didn't, then you've got bigger problems in your office than where to send the statement). The reason I ask this question is that people use that term "the insured" to mean either the subscriber or the patient. I take it to mean the person carrying the policy, which would be the subscriber. Sharon Moderator Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.
sporty981		#8	[-]
Posts: 2147 May 11 09 3:58 PM Moderator Reply Quote More My Recent Posts	This is a good topic just for discussion's sake.... For instance my husband is the subscriber for my health insurance and I go see a doctor for the first time. I'm an adult and my husband does not come with me or sign for financial responsibility. The office is going to bill his insurance as the subscriber and the statement for any co-insurance is automatically going to be in his name as he is listed as the guarantor even though I signed as being financially responsible. Another situation.... The father is the subscriber and his child who is 20 and a FTS goes to the doctor I don't go with her nor does my husband. The same thing happens she signs for financial responsibility but the insurance gets billed with my child as a dependent and the statement comes in her father's name. So for the sake of discussion is the provider at risk of not getting paid the co-insurance if the subscriber (automatically made guarantor) did not sign for financial responsibility in either situation? Karen Habel, CDA, CMBSI, CDBSI Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation. Last Edited By: sporty981 May 11 09 7:10 PM. Edited 1 times.
Doo		#9	[-]
Posts: 6236 May 12 09 12:08 PM Reply Quote More My Recent Posts	sporty981 wrote: The office is going to bill his insurance as the subscriber and the statement for any co-insurance is automatically going to be in his name as he is listed as the guarantor even though I signed as being financially responsible. Is it your software (or the software of the docs you go to) that automatically make the subscriber the guarantor for statements? Mine does not. Or is it carelessness on the part of the doctor's office? For instance, my 14 yr old teenager has insurance thru her father in Texas. The doctor's office bills United Healthcare with her father as the subscriber, and her as the patient. The statements come to me in my name in California, because I signed financial responsibility. The EOBs from the insurance company certainly go to her father, because he is the subscriber. But not the statements. You do run the risk of not getting paid if you are billing someone that has not signed for financial responsibility. I suppose this might vary in community property states, but that's a legal area I have no desire to explore. Oh, another thought... you go to the doctor's office and they send a statement addressed to your husband without your consent (which also leads me to ask what the financial resp documents include). Sounds like a HIPAA violation to me. Sharon Moderator Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.
sporty981		#10	[-]
Posts: 2147 May 12 09 7:44 PM Moderator Reply Quote More My Recent Posts	No it's not my software, mine let's you make anyone the guarantor. I think it's either the doc's software or carelessness on the part of the doctor's office. I've also seen this on accounts that I've taken over. I can see that going perfectly with your daughter as you were there to sign financial responsibility and she's a minor. Which is how it should be. I think you run a very high risk of not getting paid if the subscriber gets the statement for an adult and does not sign financial responsibility. This was just something I thought was an interesting topic that falls under HIPAA and getting paid. When taking accounts we should be careful how the statements are going out and who they should be addressed to. As well as who is financially responsible for any balance due. I would say that it's a HIPAA violation too. So now we have the adult child going to college with a FTS situation... Karen Habel, CDA, CMBSI, CDBSI Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation. Last Edited By: sporty981 May 12 09 7:49 PM. Edited 1 times.
KAbill	Re: Question about billing statements in regard to HIPAA regulations	#11	[-]
Posts: 267 May 13 09 5:22 AM Reply Quote More My Recent Posts	This is all very interesting... I refer to "insured" as the "subscriber". I still tend to think that the insured/subscriber is the one financially responsible. It's the insured/subscriber who is paying upfront thru their insurance premiums. Isn't it according to the subscriber's contract with their insurer that they are bound to pay their copays/co-ins/deductibles? If another party (mom or the adult student or whoever) has indicated and signed responsibility, I'll take their money. But the insured/subscriber should receive the statement. Now if they want to turn around and collect that themselves from the adult child or divorced spouse it doesn't matter to me. I'm throwing some things out here without research to back it up however - don't anyone take what I say as HIPAA-fact. I need to research before I say any more ( I know you'll all be holding your breath...). Again, a great topic of discussion!!!
sporty981		#12	[-]
Posts: 2147 May 13 09 6:47 AM Moderator Reply Quote More My Recent Posts	That's how many offices have done it and will always do it. You are right about the insurance contract the subscriber is bound by the terms of the contract including copays deductibles etc... As far a HIPAA coming into play reasonable effort is what is needed. If a special situation comes up where the patient does not want to release information to family then care must be taken there not to send the statement to another family member (subscriber). Then I would collect up front and have them sign a separate financial agreement and explain that if they want ins filed the EOBs will go to the subscriber. Divorces can get complicated. I had one parent in 12 years call and make sure that the EOBs went to the father and the statements went to her. Which was no problem to arrange. I still stay out of the divorce situation. Karen Habel, CDA, CMBSI, CDBSI Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.
TampaBayLady		#13	[-]
Posts: 347 May 13 09 9:38 AM Reply Quote More My Recent Posts	Wow, this topic really took off! When I initially asked the question, I was concerned about a HIPAA violation, which I am no longer am, as the patient had given authorization. But, it does raise the questions that everyone has been talking about, concerning gaurantors, subscribers, minors, and FTS. My patient is a full time student, along with being a legal adult. Her father is the subscriber and the gaurantor, and the one court ordered to pay her medical bills. If there was no divorce in the mix, I would normally bill the subscriber/gaurantor for the balance on a FTS account, even if they did not sign the financial responsibility portion of the patient form. MANY of our FTS present on their own without their parents present, and list the parent as the gaurantor, and I have never once had a parent who is also the subscriber/gaurantor call me and tell me to bill their child instead. They know they are the gaurantor, and understand that they have to pay the bill. In the case of the patient I asked about originally, it is truly her stepmother just trying to be difficult, as I soon figured out. She ended up having the post office return our statement, saying that her husband was not at that address. I called the patient, told her what was going on, and she came and picked up the statement, and will fax it to her father for payment. I can just imagine what would happen if I had tried to make every parent who was the subscriber and also the gaurantor on a child's account come in and sign the patient responsibility form on behalf of their child who presented by themselves, or with the parent who is not the gaurantor. Has anyone ever tried to do this? Let's say mom brings the minor child in, and dad is the subscriber on the insurance. Dad is listed as gaurantor by mom. Mom signs the patient responsibility portion. Should I call up dad and tell him he needs to come in and sign the form himself, or else I am billing the mother? I think our patients parents would have a fit, personally. What are others doing in this situation?
Doo		#14	[-]
Posts: 6236 May 13 09 1:18 PM Reply Quote More My Recent Posts	It's the insured/subscriber who is paying upfront thru their insurance premiums. Isn't it according to the subscriber's contract with their insurer that they are bound to pay their copays/co-ins/deductibles? Actually, most subscriber's contracts say they will not be responsible for more than the copay and/or coinsurance amount. It does not say they are legally obligated to pay. Let's say mom brings the minor child in, and dad is the subscriber on the insurance. Dad is listed as gaurantor by mom. Mom signs the patient responsibility portion. Should I call up dad and tell him he needs to come in and sign the form himself, or else I am billing the mother? I think our patients parents would have a fit, personally. What are others doing in this situation? You can bet they would have a fit. The subscriber does not have to be the person who is financially responsible for the child. Personally, I think perhaps we are overthinking things. Anyone, relative or non-relative, can be financially responsible for someone else. This is a different issue than whose insurance will be billed. But the insured/subscriber should receive the statement. I disagree with this position 100% (but that's okay - you don't have to agree with me). The person who carries the insurance has no bearing on who is financially responsible for the patient. And, as in my case, you would not have my permission to bill her father who lives 2,000 miles away from us. Can you tell I've argued with staff about this before? LOL! I say we do not insert ourselves into court issues, divorce decrees, etc., and bill the valid insurance presented, and collect out of pocket dollars from the person who signed the financial responsibility. Let them work it out amongst themselves. Otherwise, what ends up happening (and has happened in places I've worked, until I put my foot down), is that the patient is seen several times, all visits go to deductible, and the non-custodial parent says "I'm not paying this bill, I didn't sign any agreement to pay this bill, take me to court!". Then you try to get the custodial parent to pay, and they say, "I'm not legally obligated, it says so here in my divorce decree!" Oy. Sharon Moderator Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.

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Question about billing statements in regard to HIPAA regulations

Question about billing statements in regard to HIPAA regulations