HIPAA - Disclosure of PHI to subscriber spouse, but not to dependent member.

[Guest dragonflier]

I have medical coverage through my spouse's employer - the carrier is CIGNA. I tried to log on to their MyCigna.com website using my identifying information and was unable to get any information about my claims, etc.. When I called for tech support, I was told to have my spouse register for the site, and then he would have access to my information.

My understanding is that since I am an adult, he can not have access to that information with my authorization. I believe that he should have access to our child's information as his dependent.

Am I mistaken?

[Guest tbm]

I'm no expert on this but my impression is that you are probably mistaken. Unless your state laws give you additional rights or unless CIGNA's privacy policy affords you additional privacy rights other than what is generally required, there is probably not a law forbidding this. My understanding of how these things "normally" work is that the "policy holder" (your husband) will generally have access to his own claims information, as well as that of all who are insured through him. In other words, not just "dependent children" but also covered spouse. Of course, you can probably utilize CIGNA's procedures to request additional privacy protection for your claims information, if you so desire. But unless you do so, since your husband has the contract with his employer and is paying the premium and is responsible for the medical bills pursuant to that health plan, the theory goes that he should have access to information explaining what he is paying/has paid for (and the insurance company or his employer has paid for on his behalf).

[Mary C]

Under HIPAA you are not supposed to be able to access an adult spouse claim information without an authorization. I can access mine and my minor child's, but cannot access my husband's. And with our HMO, I am not able to access my 19 yr old student's information either since he is an adult.

[Guest tbm]

I'm just curious. Are you the employee whose company has insured you and your family? Or are you covered through your husband's company? It is my impression that this area of the law is not clear and various companies are handling it in different ways.

[Mary C]

I am the employee and also the benefit manager and this is how we and all our HMO's are handling this. Again, as you said, it could be open to interpretation.

[Steve72]

I have medical coverage through my spouse's employer - the carrier is CIGNA. I tried to log on to their MyCigna.com website using my identifying information and was unable to get any information about my claims, etc.. When I called for tech support, I was told to have my spouse register for the site, and then he would have access to my information.

My understanding is that since I am an adult, he can not have access to that information with my authorization. I believe that he should have access to our child's information as his dependent.

Am I mistaken?

Your understanding is correct. Your spouse should not have access to your information. However, this may be a technical...not a HIPAA...issue. If your spouse is the named insured, he or she may need to register the family on the website before any access can be given by that means. After registration, under HIPAA, each adult individuyal should have access to their own information.

[jeanine]

We allow spouses to access information that would appear on an Explanation of Benefits sent to the enrollee's address. According to either a FAQ or commentary from HHS (don't recall which), you do not have to send separate EOB's to subscribers and dependents. All that is on the EOB is limited information such as date of service, amount paid, etc. Anything requested beyond that--diagnosis, treatment plan, etc--would require either a signed authorization or proof of ability to act as personal representative. If a dependent requested alternate communications, then the EOB information would not be available to the subscriber.

[Jbentz]

I agree with Jeannine regarding the information on the EOB. This can be considered part of the payment process and is allowed without a written authorization.

[Steve72]

I also agree that payment information can be released to the named insured without authorization.

[Guest tbm]

that is/was my understanding as well.

[Steve72]

I do want to clarify, however, that information which is beyond the minimal amounts contained in the EOB (e.g., detailed claim information) about adult dependents should not be available to the named insured, unless specifically authorized by the dependent.

If that type of information is available on the website (for example, information of pending claims), only the individual to whom it pertains should have access.

[Guest dragonflier]

Thank you all for your comments and suggestions. I've just received the latest (not yet released to the general membership - being mailed shortly) copy of of CIGNA's privacy statement which spells out that they will release information to the spouse pertaining to payment issues. After we set him up for an account/access, we toured CIGNA's site and none of my Health information was listed (diagnosis, etc). Only $ information. I still have no access to my information (or his for that matter) using my login, but at least am reassured that they are maintaining privacy.