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


Guest dragonflier

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Guest dragonflier

:blink: 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?

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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).

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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.

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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.

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:blink: 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.

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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.

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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.

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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.

:)

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  • 20 years later...

I've been searching this question related to mailed EOBs of mine coming to partner's attention at home. Partner is the subscriber employed. Cigna says they can't change this but there's a lot of info I feel should not be disclosed to him via mail. He's already confirmed he can't see info online. Any way around this? I've already selected online vs mailed EOBs in my profile, yet they continue to come in the mail.  That's also a huge waste of paper I have to shred because I don't keep paper copies. TIA

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I suggest checking the plan's HIPAA Notice of Privacy Practices.  It should address your options in this area.

More generally, the HIPAA rules do permit the plan to send EOBs to the employee for all covered dependents.  However, there are rules that allow you to request delivery at a different address if you feel the disclosure of information to the employee could endanger you.

https://www.govinfo.gov/content/pkg/FR-2000-12-28/pdf/00-32678.pdf

Comment: Certain commenters explained that third party administrators usually communicate with employees through Explanation of Benefit (EOB) reports on behalf of their dependents (including those who might not be minor children). Thus, the employee might be apprised of the medical encounters of his or her dependents but not of medical diagnoses unless there is an over-riding reason, such as a child suspected of drug abuse due to multiple prescriptions. The commenters urged that the current claim processing procedures be allowed to continue.

Response: We agree. We interpret the definition of payment and, in particular the term ‘‘claims management,’’ to include such disclosures of protected health information.

...

For example, if an individual requests that a health plan send explanations of benefits about particular services to the individual’s work rather than home address because the individual is concerned that a member of the individual’s household (e.g., the named insured) might read the explanation of benefits and become abusive towards the individual, the health plan must accommodate the request.

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