[adjd2000]

I currently have the Access Plus or Pa. state medicaid insurance. To understand my questions it is important to know that I have been divorced since 2001 and have not had my ex-husbands insurance(BC&BS) even before then. My ex-husband blirted out to me several months ago after an arquement that I am a loser because I've lowered myself to having to have Pa. state insurance. He also went on to say that he knows I was in a psych ward in a Pa. hospital in 2006. I WAS FLOORED! After questioning my ex more, I learned that he has been receiving "explanation of benefits" from his insurance company, Federal Blue Cross and Blue Shield, explaining who, when, where and why I made medical visits to various Drs. From 2004-2007. These letters to him explained why the charges were paid or denied. So my anger lead to determination and I did some research. To make a long story short, my ex's insurance co. sent me copies of 6 "explanation of benefits" my ex received regarding visits to Drs I saw in 2006. On one of these statements, it stated that I was in a psych ward. The hospital that this statement listed doesn't even have a psych ward. So this BC/Bs paid a few thousand dollars to various Drs. For me and should not have. My ex stated that as far back as 2004, he called his insurance co. because he thought I was committing insurance fraud by giving his insurance info to the Drs I saw since 2004. This was not the case at all. What I was told happened by my case worker from medicaid was this. Somehow the Pa. medicaid program had my ex's insurance listed for me as well. Because of this, medicaid submitted charges to BC/BS for each Dr. I visited from 2004-2007. Actually, I have only has this medicaid since 2006. They submit these clients charges to what they have listed as current providers to be certain this client is no longer enrolled with this particular insurance co. However with me, the "explanation of benefits" my ex received listed my coverage as the "Pa. Dept of Public Welfare." As I said above, the Drs. And facilities I visited(or didn't) were also listed. What I need to know is if the Pa. state medicaid was in violation (privacy) when they sent my ex info that I was in their program? I also want to know if the Pa. medicaid system has the right to look at my past insurance providers? Also, was it a big time HIPPA violation to provide my ex with these "explanation of benefits?" My husband, after receiving the "explanation of benefit" thought because I was in a pysch ward, he had ammunition to fight for full custody of our 12 yr old son. He thought he could have me labeled as mentally incompetent. What is funny is the hospital that was listed for a psych admission was in error. I do visit a pain clinic at this hospital monthly, so someone coded this visit incorrectly. I have worked very hard to be a private person. I have even worked harder to keep my medical issues private from my ex just as they should be. What I do not understand is how and why BC/BS was listed. This because when I spoke to BC/BS I was told my coverage with them terminated in 1998(my legal separation date). You should know that after explaining this to my case worker a few months ago, he got into his system and sure enough BC/BS was listed for me as an insuance providor. He then deleted this info and I can be certain my ex will never be aware of any Drs. I visit from here on out.

[ScottGem]

This is tricky. Clearly a mistake was made in listing your insurance coverage. But as long as the system believed you had that coverage, it was within its rights to file a claim with all the attendant notificiations.

There was a violation of privacy, but I'm not sure that you have suffered sufficient damages to collect anything. I would consult an attorney familiar with PA insurance law to see if you have any grounds for a suit.

[Fr_Chuck]

I think the fault can lie in him opening your mail, since these should have been addressed to you.

They can give under HIPPA your medical information to another insurance company, and they are reqired to mail you a determination letter.
So if he received a letter in your name, he committed a postal crime in opening your mail.

My opinion anyway.

[ScottGem]

Sorry Chuck, but if the policy is in his name, then the EOBs would be sent in his name.

[adjd2000]

Sorry Chuck, but if the policy is in his name, then the EOBs would be sent in his name.

Scott Gem is right. The EOB was addressed to my ex so it was mailed to him. Could BC/BS be the one I build a case against because my divorce decree stated the coverage with them was ordered to stop one year after the date of divorce? This date was 3/29/02. Could my ex be prosecuted if I find out he did not notify BC/BS of the date of 3/29/02? What is ironic is that I submitted a physical charge from my Dr. I had in 2001 and BC/BS refused it then and to date state that they cannot discuss this issue unless my ex gives BC/BS permission to speak with me. So they refused to speak with me when I should have been legally insured and was no t. BC/BS did tell me on the phone today that the only thing they can tell me is that my coverage was terminated in 1998. Again, I am shocked. Also, was it a privacy violation for BC/BS to list my name as having coverage when I did not? This then led the Pa. medicaid office to submit charges that then led to my ex receiving sooo much of my private medical info. He should have NEVER received this info.

Thank you.

[ScottGem]

Consult an attorney. Your case is complex and tricky. It could go in different directions.