Physician Practice

Q&A: Withholding information from a patient’s insurance company

Physician Practice Insider, March 24, 2015

Q: How should an organization handle patient requests to withhold protected health information (PHI) from the patient's insurance company?

A: Patients have a right to ask that their insurance companies not be billed for specific encounters. Most healthcare providers require that patients pay for these services themselves before agreeing to provide the services and not bill the patient's insurance company. Your organization should have a policy and procedure in place to handle such requests. You'll probably want the patient to make the request in writing. You'll need to ensure that the information about the encounter is secured in the patient's medical record, so it isn't released with any future requests from the insurance company. You'll also need a mechanism to bill the patient directly and prevent a bill for the services from being sent to the insurance company.

Editor’s note: Mary D. Brandt, MBA, RHIA, CHE, CHPS, vice president of health information, Central Texas Division, Baylor Scott & White Health in Temple, Texas, originally answered this question in Briefings on HIPAA.

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