[liberty123]

This past week I received a statement in the mail from our Primary Care, the amount due is $118.00. The date of service is March 28, 2011.
I knew that I had done it reaching over my back seat and grabbing my briefcase and lifting it into the front seat. Our PCP said I could have a cortisone shot, or give physical therapy a shot. I chose the physical therapy which did the trick. So this bill arrives.
I called them on 7/5/11 at 12:10pm, they stated that Blue Cross Blue Shield had denied the claim due to the injury being related to a car accident in September of 2009.
At 12:30 on 7/5/11 I get ahold of them and was told that they denied the claim as it appeared to be related to a car accident I was in on 9/23/2009. My jaw literally dropped, I asked her how they even knew I had been in a car accident, she stated the information was provided by the hospital system.
The day of the accident an SUV ran a stop sign, and I t-boned them. There were a lot of witnesses, and Jax Beach fire rescue and police were there in just a couple of minutes. They were awesome, they secured my case files, laptop, camera, and called my husband.
Fire Rescue offered to transport me, but my husband arrived, and he took me to the hospital. We had already been on the phone with our insurance company , and we did provide the claim number to the nice lady in the ED with the laptop on a cart. The police also came to the hospital with me.
The injury sustained in the accident was to my left forearm-huge hematoma from the air bag, it was x-rayed, no fracture, and I was released, with prescriptions and directions to follow up with my doctor, who would not see me due to the accident.
I have all of my documents, receipts, and correspondence between myself, our insurance company, and State Farm(the other insurance company). My car was totalled.
I have requested all of the documents that Blue Cross Blue Shield has, and information as to how they obtained my records from the hospital. I did not give consent for any of this information to be released to anyone for any reason-aside from my vehicle insurance company and State Farm.
So who violated HIPAA?
I requested an investigation as to what happened, and how will I ever feel comfortable walking in to see my doctor, or use the hospital where I have been a patient for the past 19 years.
Are there grounds to sue for violation of privacy due to not consenting to the release of information to Blue Cross Blue Shield?

[J_9]

Did you have BC/BS at the time of the accident in 2009?

[liberty123]

Yes, but we provided the hospital with the claim number and insurance info for our vehicle insurer. Did not consent for this info to be released to anyone for any reason. Thanks

[J_9]

BC/BS is your health insurance correct? If so, then what they did is called cross-referencing you claims. This is not uncommon and absolutely NOT a HIPAA violation, as they have access to every time you have been to the doctor/hospital/pharmacy.

[J_9]

To add... Cross-referencing is done to prevent insurance fraud. I'm not in any way saying that this is what you did, just letting you know why it is done.

[ScottGem]

Even if BC/BS was not your insurer at the time, there is no violation. When you signed up with them, you signed a agreement to allow them access to all your medical records.

Your focus should be on fighting the determination of the claim, not trying to find a HIPAA violation that gets you nothing.

[liberty123]

Being a state investigator of 14 years in child abuse and adult protective investigations my read on Hipaa was that no information could be released to a third party without my specific consent. Did I get this wrong? There was no intent to defraud any insurance company-as you can see the injury was to the left forearm-major hematoma. The claim they denied was to the right shoulder, which was never injured.

[J_9]

Have you read up on HIPAA? If not, here is the link.

Health Information Privacy

[ScottGem]

Your read is wrong. A third party is someone not involved in your care. Your insurance carrier doesn't fall into that category.
And again, even if it was a violation, it has no bearing on your fighting the claim.

[liberty123]

Have read PQSIA, though it does provide some proectections for third party sharing, it still does not excuse disclosure for the intent of denying a claim that was unrelated, and looks like BC/BS was hunting for a reason to deny the March 11 claim.

[liberty123]

Sorry-protections

[J_9]

Let me explain, in layman's terms, what HIPAA is. Basically it is what used to be called doctor/patient privilege.

Insurance companies have the right to cross-reference claims due to increasing insurance fraud and consequential litigation.

Again, as I stated, I don't feel that you are trying to fraud your insurance company, it's just been a big business recently.

What you need to do is go back to the hospital and request a copy of your records from the accident, and the same thing from this recent injury. Compare the two, and speak with your insurance representative to clear this up and show that they are two different injuries on two different sides of the body.

[ScottGem]

looks like BC/BS was hunting for a reason to deny the March 11 claim.

Of course they were. That's what insurance companies do. That's also why there are insurance departments in each state to review such actions. That's why you need to fight the claim and you have good cause. But trying to use HIPAA to fight the claim is not going to get you anywhere. Fight the claim on the fact that the injuries are unrelated.

[Fr_Chuck]

Please understand there is in the insurance industry, when you buy insurance, even car or house or life or medical, you give a release for all of your insurance records. Also when you apply at a job, normally you give a release.

Also some of the larger insurance companies may even use a central clearing house for certain type of medical equipment. I know in our industry, there is one company that does the processing of dozens of insurance company paper work.

[liberty123]

Okay, thanks for the input. Now can focus my energy on the claim instead of fretting over the invasion of privacy or violation of Hipaa. Appreciate the replies.