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AT THE DOCTOR'S OFFICETesting Can Be Hazardous to Your Health InsuranceThe Annoyance:I'm thinking about getting tested for HIV. But I'm reluctant to go to my regular doctor, because I'm afraid my insurance coverage could be cancelled if the test is positive. Do I need to worry? The Fix:You might. The test results will become part of your medical record, which can be shared with a wide range of entities under the Health Insurance Portability and Accountability Act of 1996 (see "Getting Hip to HIPAA"). If you pay for the doctor visit using private health insurance, that information is almost certainly going to end up in medical databases and follow you the rest of your life. The very fact that you had the test, even if it turned out negative, may be a flag to some insurers that you are high risk. One option is to be tested anonymously at a local free clinic. Such services don't collect personally identifiable information when they collect your blood sample so you'll be able to get the results without creating a traceable record of them. You'll find a nationwide directory of clinics at the Free Clinic Foundation of America's site http://www.freeclinic.net and HIV testing centers at http://www.hivtest.org. Anonymous testing is available in 40 states and the District of Columbia. The remaining ten allow only "confidential" testing, where the results can be shared with other health professionals and state health agencies. States that only allow confidential tests include Alabama, the Carolinas, the Dakotas, Idaho, Iowa, Mississippi, Nevada, and Tennessee. All ten require doctors to report your test results and your name to state health authorities. For more information on the reporting requirements for each state, visit the Henry J. Kaiser Family Foundation's State Health Facts web site (http://www.statehealthfacts.org). Another option is to find a so-called "country doctor." This is a movement of physicians who've declined to become "covered entities" under HIPAA by not transmitting protected health information electronically. (Country doctors can still keep records on computer, they simply can't transmit them.) By definition, such physicians don't accept insurance or Medicare payments, so all medical expenses will come out of your pocket. (However, such doctors are still subject to state reporting rules and disclosures to law enforcement.) Depending on the laws of your state, using a country doctor may mean giving up some of HIPAA's benefits, such as getting copies of your medical records. At press time, the American Association of Physicians and Surgeons was attempting to create a directory of such doctors. Check their web site (http://www.aapsonline.org) for updates.
Keep Your Hospital Stay PrivateThe Annoyance:I'm going in for some elective surgery of an extremely personal nature, and I don't want my gossipy coworkers or friends to know about it. How can I protect myself? The Fix:First, tell the hospital or other care facility to take your name out of their patient directory. Some facilities may ask for your permission before they list you, but they're not required to so anyone who knows your name can walk up and inquire about what room you're in and your general condition, though not the type of treatment you're receiving. If you've checked into the oncology wing or the maternity ward, however, they can get a pretty good idea of why you're there. According to HIPAA rules, upon admittance you should be given a form where you can specify the types of medical information you're willing to share and with whom. Even so, your control over this information is ultimately quite limited. Privacy advocate Robert Gellman estimates that if you get treatment at a hospital and pay for at least part of the treatment using an insurance plan, anywhere from 1,000 to 10,000 people from hospital staff to insurance company administrators to university researchers could have access to it. Many of them are not covered under HIPAA. But there's a downside to keeping your hospital stay under wraps, notes April Robertson, corporate compliance officer for ChartOne, a medical records management firm in San Jose. "You won't get flowers, get well cards, or phone calls, and if your old auntie shows up in the lobby during visiting hours, she won't get to see you," she says. Robertson suggests you ask the hospital if they'll let you choose a password that you can share with your family, so you can choose who gets to visit while you convalesce. Bottom line? If you don't want anyone to visit or call, don't tell anyone you're going to be in the hospital. If you think someone is looking for you and likely to do you harm, warn the hospital (preferably when you schedule the procedure, not at the time of registration) and they will take appropriate measures. If you really want privacy, don't use insurance and pay the bill out of pocket. Medical Marketing MigrainesThe Annoyance:A few weeks ago I got a prescription filled for medicine to treat a chronic condition. Now I've started to get solicitations in the mail for similar medicines. Who sold my name to these guys, and what can I do to stop them? The Fix:This is one of those lovely little loopholes in HIPAA. Your doctor or pharmacy can share your information with marketers under the guise of providing information about "alternative treatments." For example, your drug store may contact you at the behest of a pharmaceutical company to see if it can persuade you to switch brands of anti-depressant. You can opt out of receiving future marketing dreck, but only after you've received the first one. Worse, you'll have to opt out separately for each healthcare provider that sells your information and for each member of your family who is contacted. The law specifies no standard opt-out method, so the procedure for getting your name off a marketer's list will vary. You might attempt a pre-emptive strike by telling your doctor or pharmacist to not share your contact information with anyone. The Association of American Physicians and Surgeons has developed a model nondisclosure form you can give to your doctor, dentist, or other medical professional that demands they not release your personal health information to third parties. (You can find it at http://www.aapsonline.org/confiden/patientadvisory.htm.) If the marketing is allowed under HIPAA guidelines, your physician isn't forced to comply or even acknowledge your request. But if she doesn't honor your requests, you probably don't want her as your doctor.
Report Privacy GaffesThe Annoyance:I've recently changed doctors. My old doctor's office tried to fax my treatment records to my new physician, but they goofed and sent my entire medical history to some stranger's fax machine. The Fix:Technically, that office has violated HIPAA's guidelines for data security. Fax machines are notoriously insecure devices even when the documents arrive at the correct number anyone can come by and have a look at what's being printed out. But your doctor's office needs to exercise more caution in how they handle your records. If you believe your physician's office has violated the HIPAA Privacy Rule, you can report them to the Department of Health and Human Services' Office of Civil Rights by mail, fax, or email. You'll need to fill out a form detailing how the doctor violated your privacy, along with supporting materials and your full contact information. (For forms and detailed instructions, see http://www.hhs.gov/ocr/privacyhowtofile.htm.) The offending medical practice can be fined $100 per incident, but the odds of that happening are slim. More likely they'll get a letter warning them to clean up their act. A better solution would be to request a copy of your medical records from your old doctor you're legally entitled to it, under HIPPA regulations. Then bring a copy to your new physician and keep one at home for your own records.
Be Careful What You Tell Your DoctorThe Annoyance:Some of my personal habits aren't exactly mainstream or strictly legal. But they do impact my health and I'd like to talk to my doctor about them. Am I protected by rules of doctor/patient confidentiality? The Fix:Not necessarily. What you tell your doctor isn't as private as you might think. Confidentiality laws vary widely by state, and in many cases physicians are compelled to report certain conditions. For example, doctors may be required by law to report certain communicable diseases such as smallpox or tuberculosis to public health officials. Gunshot or knife wounds and suspected cases of child abuse must be reported to the proper authorities. Six states require doctors to notify their state department of transportation when patients have a condition such as epilepsy that could keep them from driving safely. In August 2004, a Pennsylvania man lost his driver's license after he told his doctor he drank a six pack of beer each night. A court subsequently ruled his license could be reinstated, but only after he installed an auto ignition system that contained a blood alcohol analyzer. The Bush Administration's Department of Justice has asserted there is no such thing as doctor/patient confidentiality. Last year the DOJ sought the medical records of women who had undergone late-term abortions in California, Illinois, Michigan, New York, and Pennsylvania, claiming that it required these records to defend the late-term abortion ban passed by Congress but overturned by the courts. After being spurned by judges in nearly every state, the DOJ ultimately dropped its demands. Despite that victory, doctor/patient privacy is hardly assured. Even privacy-conscious doctors may voluntarily disclose information if they believe the health of the patient or of other parties is at stake. And HIPAA puts no more restrictions on doctor confidentiality than existing laws, says privacy consultant Robert Gellman. "Anything you tell your doctor can be given to the police, city or state health departments, national security agencies, researchers, or dozens of other institutions," he says. "When you talk to your doctor, you must make a tradeoff between protecting your privacy and getting the most effective health care."
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