HIPAA’s Privacy Rule |
Buying or Changing Health Plans |
What Organizations Does HIPAA Apply to?
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted in an effort to:
- Establish national standards for electronic health information transactions
- Secure the privacy of health data
In addition to protecting your privacy, HIPAA may also:
- Reduce the chance that you will lose your health insurance
- Make it easier for you to change insurance if you lose your coverage or do not have any insurance
And although it was designed in part to simplify matters, healthcare providers continue to struggle to understand and meet the requirements of the act. This gives you—as a healthcare
consumer—all the more reason to understand what HIPAA basically means to your care. That way, you can be confident your information is being handled properly, and take action if it is not.
HIPAA’s Privacy Rule
HIPAA is perhaps most well known for its Privacy Rule. The intent of the Privacy Act is to give people more control over the sharing of their personal medical information, while at the same time making it easier for them to access details about their own health and healthcare.
According to the Privacy Rule, healthcare providers cannot reveal your health information to employers or others who are not entitled to view it. For example, they may not pass on information to companies who are thinking about hiring you, or who want to sell you their latest cures or devices. Also, they may not share any information about mental health consultations.
The Privacy Rule protects information in your medical record, conversations your doctor has with nurses or other medical professionals about your care or treatment, information in your insurer's computer system, billing information, and most other health information.
However, there are cases when information can be legally shared. Your health information can be shared for certain reasons, including:
- Doctors, hospitals, and insurance companies for purposes of billing and payment or to coordinate care
- Anybody in or out of your family whom you designate to help you with your healthcare
- Safety regulators looking into care at nursing homes
- Public health officials under some circumstances (eg, reporting when the flu is in your area)
- Police when a crime is committed
The Privacy Act also gives you greater access to this information. Whereas at one time it was often difficult to view your own medical charts and files, you now have the right to know anything pertaining to your health. Under HIPAA, you are legally entitled to:
- Receive a copy of your health record if you ask for it
- Make corrections in the official file
- Be told how your health information is used and who it is shared with
- Choose whether you want your information to be shared
You also have the right to file a complaint with your healthcare provider or with the federal Office of Civil Rights if you think your information has been misused. Call the regional Civil Rights office nearest you for more information. You will be asked to provide the specifics of what happened and the reason for your complaint.
Buying or Changing Health Plans
HIPAA offers some protections if you have one of the following types of insurance coverage:
- Health insurance through employers
- Individual (non-employment based) health insurance
- Coverage through a high-risk pool
While the law is complex and has limitations, here are some protections that HIPAA provides:
- Allow you to buy insurance even if you have pre-existing condition
- Stop health insurance companies from denying you coverage because of your health or your family member's health
- Guarantee your right to buy insurance
- Guarantee your right to renew your insurance
What Organizations Does HIPAA Apply to?
The HIPAA mandates apply to just about anybody who deals with your healthcare, including:
- Doctors, dentists
- Hospitals, clinics, nursing homes
- Drug and medical equipment providers
- Third-party medical billing companies and clearinghouses
- Health insurers, group healthcare plans, HMOs, Medicare, Medicaid, and other government sponsored healthcare programs
Health insurance reform for consumers. Centers for Medicare & Medicaid Services website. Available at: https://www.cms.gov/Regulations-and-Guidance/Health-Insurance-Reform/HealthInsReformforConsume/index.html?redirect=/HealthInsReformforConsume/. Updated February 27, 2012. Accessed August 14, 2012.
HIPAA - general information. Centers for Medicare & Medicaid Services website. Available at: http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/index.html?redirect=/HIPAAGenInfo/. Updated April 12, 2012. Accessed August 14, 2012.
Frequently asked questions about portability of health coverage and HIPAA. US Department of Labor website. Available at:
http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html. Accessed August 14, 2012.
Health information privacy. US Department of Health and Human Services Department website. Available at:
http://www.hhs.gov/ocr/privacy/. Accessed August 14, 2012.
Statement of
HIPAA portability rights. Arizona Health Care Cost Containment System website. Available at:
http://www.azahcccs.gov/privacy/Downloads/StatementofHIPAAPortabilityRights.pdf. Accessed August 14, 2012.
Understanding HIPAA privacy. US Department of Health & Human Services website. Available at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. Accessed August 15, 2012.
Your health information privacy rights. US Department of Health and Human Services website. Available at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/consumer_rights.pdf. Accessed August 14, 2012.
Last reviewed August 2012 by Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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